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� l r 3, h b APPLICATION FOR SANITATION PERMIT Permit No. ....__ __//__7_..7I. . _ (Complete in Duplicate) Date Issued ._�-14/S` Applica+ion is hereby made to the San Joaquin Local H th District for a permit to construct and install the work herein described. This application is made in compliance with County Ord ante No. 549 ) �- ,,�/ ATION...�__.3Z_ ----- --------- JOB ADDRESS AND L d Owner's Name------------- ------------ ---- ---------------------------------- Phone---------------•----...---- Address-------.. ------------------ --------------- ---•-- Phone-A----kf,4017---- Contractor's Name [ Installation will serve: Residence A�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ___ZNumber of baths __/. ~ Lot size ------------------ Water Supply: Public system 2--'C'ommunity system ❑ Private ❑ Depth to Water Table -s—oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9--oardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if publicseweris available within 200 feet.) ptic T Distance from nearest well-----------------Distance from foundation--------------------Material---------------.-----------._-------__-_________- No. of compartments----------------------- - Size------:=---------- -----•---.---Liquid depth---------- ---- ------Capacity-•--------------------- f sal Fie d:.. -'-Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line....___..___._.-_ 11+► JNumber of lines------------------ ---------------Length each line.------------------------------ of_trench----------------------------------- 1 Type of fil r materia-- --._. Total length-_-_---.----•----------------------------- ' ��// r T e of filter materia --------------•.-; D stent rom , Undaflon --Q_________.___Distance to nearest lot line----------------- .5 -. _____ ° Seepage Pi Distance to nearest well--- ___ _ _ -__ Number of pits___."-i___________Lining m terial_:" ___. Size iameter__ _ __________De tn_.c�. _ Cesspool: Distance from nearest well----------------- stance from f' ation_ ________________Lining material__.______..____._._._-_-_- ❑ Size: Diameter-------------------- ----Dery ----------------------Liquid Capacity----------------------------gals. .. Privy: Distance from nearest \Iiell...........___________#__ -------.------.------Distance from nearest building-_______.____.______________..__-.______- ❑ Distance to nearest lot line-- --- ------------------:.- .......... ---------------------------•----------- -------------------------------------•--------------------- T Remodelingand/or repairing (describe):--------- ---------------- ------------ ----------------•-------------•--- .-......-•-----•--------•----------•-••---------------------------.._... ----------------•-------------- ---------------------------- ---------••------------ -----------------------------------•----------------...........--------------------------•---------------------•------ ----------------- ----- ------- --- ------------------------------------•-- ----------•-•------------------•-�'-------_.-..•------------------•--------•-•---------------------------- ---------------- I her certify tha I have prepared this ap�..sslicativn�ndhthal the i4o'k will be done in accordance with San Joaquin County ordinances, te'l'aws d rules and-regdIationX fhe San Joaquin Loc I Health District.�._�� 'a fel Si ned --------- -- _ r Contractor) { �9 } --- -- - -- ------- ----- - - e 6 x (Title) f ! ----------------- r•-- -- -- ----- -- - - - -- -- (Piot plan, showing size of lot, location of system in rela on to wells, buildings, can be pl ced on reverse side). FPKDEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------- -- - ---- ------------------------- DATE--------- ------------------------------------------ REVIEWEDBY-------------------------------------- -- - - -------• .----- DATE-------- - __7S711'�---------------------------------- BUILDING PERMIT ISSUED---------------------------------- --- ---E. DATE--------- ------- :--- � ----- Alterations and/or recommendations----------- -------- - ------------------ --------------------------•-•--------•--- --... ......-3--- --------------------------------- ------------_- . ...... .......•-•-•---- ------------------------------------ ----- -- ----- ------ ......------ - ------------•--------------------•-• ---- --- ----- ------ ------_-------- -�---- --- --------- -`�� ----- ------------------------------------------------------------------------------ ---------------- - - ------------------------- --------- ----------- -------------------------------- FI -------------- FINAL INSPECTION BY-- -- ----------- ---------- - ------------ Date------/-�-----------/ - -- t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street f 32 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M 145446 AT W OOO 12.54