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APPLICATION FOR SANITATION PERMIT Permit No. .qA-�-A___---- (Complete in Duplicate) Date Issued _____°�/y 4 ______ _ .. II Applica+ion €s hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordina ce No. 549. a' y. JOB ADDRESS AND LO TION___ .- -- --- ------- Owner's Name----------- 6 : �' 4 '' Phone Address - -.: ' 1 - --------••--------------------------------•-- I------------ Contractor's Name - - ---- -- ---- -------------------------- -------------------------------------------------- Phone-------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [-I Other ❑ b: Number of living units: ---L Number of bedrooms --- Number of baths - -- Lot size __-_. _ '* -------------- Wafer Supply: Public system El' Community system rivate E] Depth Depth to Water Table ._ ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam �C€ay Loam.❑ Clay ❑ Adobe ❑ Hardpan ❑ F Previous Application Made: Yes ❑ No ( New Construction: Yes ta—No ❑ TYPE OF INSTALLATION,AND,SPECIFICATIONS: --�- --. -.- -a -- �- (No septic tank or cesspooT .f permitted if public sewer is available wifhin 200 feet.) Septic Tank: Distance from nearest w�ll--1 Distance from foundation__.A�--_-----.Material_ -- i- -----_-__- No. of compartments-. -_______________Size__ X11 P `� �-_�✓_�----Liquid de�th_---{---�-- ---------Capacity----------$�--��-f__. , �- ��-.-_--_-_.Distance to nearest lot line- _.'�__.---___ Disposal Field: Distance from Weare well. - t�Distance from foundation____ - -. f.,� Number of lines------ -------------- ----- ---Length of each line--- �-`__ _T/-----Width of trench----- - Type of filter material_ __/:Yf Depth of filter material_----I -.----_---Total length------�P—V _-___--1--__-_----.- / 1�-- F Seepage Pit: Distance to nearest well.... '-_Distance from foun btion..- �__ -_._.D' t� to nearesf to line.-/e---_---- Number of pffs-----f_______-------Lining materialCG_ .: .___ ize: Diameter Depth. 11 A Cesspool: Distance from nearest well-----------------Distance from foundation------------- -.--..Lining material--------- _-_-_.._ -- °I -- ------ ❑ Size: Diameter - .....Depth...: -------------------- Liquid_Capacity-_,. _r9als.,,, `�F, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line---------------------- ----------- ----------------------------•--•--- Remodelin and/or repairing(g (describe);----------- I ---- -------------------------------•-•-••--•-----------------------------•---------- ------------------------ ---- -- I j I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)................................ =' - "� _ z c t-Cvntractor) _. BY: L? -- Title= . �---� [Plot plan, showing size of I cation of system in relation to welts, buildings, etc., can be placed on reverse ode). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------------.------- ----------------------------------------------------- DATE-------5- REVIEWEDBY------------------------- ---------------- - ---- ------ --------------------------------------------------- ----- DATE---------- � i BUILDING PERMIT ISSUED - DATE �_------------- ---i°- Alterations and/or recommendations--------------------N--�---- ------------••-----•-•-----------------------I—------------•------------- •. ---- 'i -----------------------------------------•---------------------------------- ---------------------------------- ------------------------------ ----•----•--•-------------------------- -- --------------•----------------•------ 21------------------- -- ---- ---------- ----• --- = - ---------- ------------------------- ---- •------ -}---- ... ..�-"�`- - - - -- - --- --- ---------------------------------------------------- FINAL INSPECTION BY:------ - ' ----------------------- Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street' 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California !Manteca, California Tracy, California Es- 9 745446 ATWDDD