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APPLICATION FOR SANITATION PERMIT Permit No. ____- 3 O 3 1 {Complefe in Duplicate] �jj�(j � �. • p _ Date Issued Applicallion is hereby made to the San Joaquin Local Health District for a permit to construct and ins 1 t we d rib This application is made in compliance with County Ordinance No. 549. ��at,(}; 81 JOB ADDRESS ANDL CATION-------- ----- __. ------ Owner's Name--- -- ---- -_- --- --- --------- Phone----------------------------------- Address.---l ...-•-. _v p" 4 Contractor's Name_..--d.. . = - -- --------------------------------------------- Phone ____- 7 -6 -L Installation will serve: Residence jtjAparfmenf House ❑ Commercial ❑Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms J--_ Number of baths tj_-_ Lot size _t_0------ _J...Q._--_-_____________________ Water Supply: Public system".(Community system ElPrivate [_1Depth to Wafer TableuQ_`ft. „s-^' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No A.. New Construction: Yes,❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_,____Distance from foundation__./0--1 _ Makerial- _ __._____ ________________ __________ ... No, of compartments----____.�,,_----_ Size__S-4---kt4b---Liquid de1?th__. ___ Capacity ----- Disposal Field: Distance from nearest wel1_0010 L.---Distance from foundation-----1_10_.4_.__.Distance to nearest lot IiF e____S�_---__- �� Number of lines______________ ____ __ ___ ------Length of each line----____ . ___------Width of trench____!.Z :___------- _____Depth of filter material___:._. _.____ Type of filter materiaL,____�,__ __._ p � Tofial length--------- Seepage Pit: Distance to nearest wellies-&*---------Distance ``m� '�fo��uundafion____,/__C:2____-..Distance to nearest lo/line---- Number _Number of pits--____�--------------Lining material____ t'A %0 „-.Size: Diameter_-.- __--_--_.Depth--2Cesspool: Distance from nearest well____________._-_Distance from foundation_.________________.Lining material___________ ____Size: Diameter---------------------- - --.De th----------------- -_---- ---- ---Li uid Ca acit als.0Distance t --�+ -� - ---o-- ----�--- ---��---Distance from nearest buildig Y--------- -,� rom st Privy: Distance to nearest lot,lime......... ------------------------ ------------ • -----------:-.-- - ---- ------------- ---------------------------------- owl ----- --------- ------------ Remodeling and/or repairing (describe -_-- ---- ----------- ------------------ -----•----------------...-.-.._.. ----- ----- - = ------ ------------------------------------------------- �- ------�--- �/' ----••----- t --------------------- - --------- ----- --- -- Q----�1-------�---��-- --- ---I--- � �. b -------------------------------------- I ` her by certify that l have prepared this application and that the wor will be done in accordance with San Joaquin ordinances, State laws, and rules and .regulafons of fhe San Joaquin Local Health District. (Signed)--- - --- --- -=- ------ - ------------------------------------- -------'------- - .-[ Contractor) By:........... - -- -- •- •---_--- _ - _=_= [Title a - .�`° - (Plot plan, showing size of lot,,locafion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY-------------------------------------- ----------- --------------------------------- DATE------------z- "�`" ..`tr'---------- REVIEWEDBY ---------------------------------- DATE------ --------�--------------------------------------------c � BUILDINGPERMIT ISSUED----=-------------------------------------------------------------------------------- ------ DATE---------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------- ---.------•--•---•----•-••-•--,--------------------•-----------•-----------------------.._..-•-•----- ------------------------------------------------..._......---•--•------------•--•------------------------------------ -----•-- -------------------- •-------------------:-------------------- --------------------------------------------------------------------------------------.. . ------------------------------------------ -- _ ----------------------------------------------------- ------• -------- - -------------- ---------------------------------------------- ----------------- ----------/-------------- -------------------------------- FINAL INSPECTION _____ Date------- ----------------------------------------------------------- B . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E_9-5]-2M 145446 ATWOOO '12-54