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' APPLICATION FOR SANITATION PERMIT Permit No. _A;1)......._._ (Complete in Duplicate) Date Issued _YA/ _ Applica{ion is 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 Ordinance No. 549. ;_C JOB ADDRESS AND LOCATION... "111h. Name--d._i_� atz Phone ------------------------------------ Address--- -- -----------•-----•--- ---------------•--•---.......--------------------------------------------•--------•------- Contractor's Name__._. _ __ . -'1`'---- -- -- Phone _, �_..S!_ C �4 i Installation will serve: Residence 4—,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f -_ Number of bedrooms ___2, Number of baths __ ___ Lot size _____ __ ---------------____________ Water Supply: Public system Ej Community system ❑ Private P4--aepth to Water Tabled ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ n Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic flank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _:S0------Distance from foundation__.___p______.Mate�iai____ __ __... ....... ----------------- . No. of compartments._---- ----------Size_Slr_.X__-�(_?___Liquid depth__._.t!-_____-.Capacity___-fe,,r� Disposal Field: Distance from nearest welLilP------Distance from foundation-----.2 __....Distance to nearest lot line._ -______ Number of lines----------f_-...+_ �i_.,. Length of each line-------.1 _______________Width of trench___2, ------------ Type Type of filter material__/_,'r...__.J?_ _Depth of filter material--------t.,e._�'!�.Total length..... Seepage Pit: Distance to nearest well---- �.0___._Distance om-foundation-------7.J__.Distance to nearest lot line__/.O___-___ �_ Number of pits-------C______-------Lining mate ria L__11.-VX----Size: Diameter___,2__�__4-..___-Dept h---?_.a__._________._-_----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------- ----------------- - O ❑ Size: Diameter---------- ---------------------------Depth-------------- -------------------------------------Liquid Capacity----------------------------gals . r_ Privy: Distance from nearest well---------------------------------- -----------Distance from nearest building----------------------------------------- El _- ----❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)________________________ ---------------------------•-------------••-----------------------------------------------------------------------------------•--------------------------------------------------------------•-------I----------------------- i ------------------------------------ --------- -------------------------------------------------------------•-----------.........................-----•-- -•------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws and rules and re ulations of the San Joaquin Local Health District. (Signed)----- - -- ---------- < ---------•--------------------------------------- wdf6'or Contractor) C By:------ ----------........... ----------------- (Title) ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_� __._ DATE- _----------------------------------------------------- REVIEWED BY--------------------------------- - DATE-- ------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ -----•---------------------------------------- Alterations and/or recommendations------------------ - --------- ---------------_ ___ ------ ------_--•------•-•--•-----•-----•-•----.---------------•-------•------- -------------------------------------------------- •----------------------•---------------•---•---------------• -•-----------------------------•---------- ---- -------------------------------- FINAL INSPECTION BY: ---.-_-�_�-�f----------------- ---------------------- Date---------------------------------------------------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California E$-9-2m 145446 AIWpDD 12-54