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Permit No. s APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued --- -- _ _S_ zp Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and instal r ` rein cribed. ! This application is made in cam Iian5 with County Ordinance No. S49• s LE � ---•�- �. JOB ADDRESS AND LOCATI --`_ � 0 Phone--------------------••-------------- Owner's Name.�7cr�°_----- _ �L<°�------------- I Z Address = . m-- ---------------- ------- --------- ------------------------ -- --- Contractor's Name r' ' - Phone.. ', s1. 1 f� ------ •--- -- Installation will serve: Residence/[Apartment House E] Commercial ❑ Trailer Court E] Motel [-] Other E]Number of living units: -_!-__ Number of bedrooms _-- Number of baths __/__ Lot size ----- '_____________--_ Water Supply: Public system ❑ Community system ❑ Private 23'Depth to Water Table"Q9 ft. `. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam 0 Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑1 No ® New Construction: Yes �No ❑ TYPE OF INSTALLATION.AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public ewer is available within 200 feet.) , I r Septic Tank: Distance from nearest well_____.Distance rom foundation----Z�____---Material-_4 __ - ____ ..__ ___.._. No. of compartments____ ____________....__Size-��_ ---- -.-- -_ Liquid depth__.__,-" Capacity.. ---_-_ � f - 2 J-1 Disposal Field: Distance from nearest well_ -------Distance from foundaf n_rl�-____.-__.Distance to nearest lot line._la_______. Number of lines_'__.__________________ __ Length of each line__ __ .----.----.-.Width of trench_____ ._________-____.____ Type of filter material-/z._ -_._. -Depth of filter material---/�'fr____-Total length_________ __ _______ _____________ L Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_.__--_----._____ [^: ❑ Number of pits-`--------------------Lining material-----------------------Size: Diameter------------------ ----Depth--------------------------------- i � r Cesspool: Distance from nearest well-----------------Distance from foundation.----.--------------Lining material_-----------___.____.______________- ❑ Size: Diameter---------------------- ---------------Depth------------------------- --------------------------Liquid Capacity---------------------------- ! Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------._..----------------- . ❑ Distance to nearest lot line------- - ------------------- -------------- ------------------- ------------------••-------------=---------- ------------------------- Remodeling and/or repairing {descil,e):_______.. .. _ - ---- ---^- ------ -------------- .. -----•-----------------------....- ---------------------------- ----------•----------•-----------•-••----------------ll--------------------------------------------------------V------------••------------•--•-----•-------------------------•---------------------------------------- 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, State laws, and rules arid regulations of the San Joaquin Local :Health District. (Signed)------------------• • �'------- - --- ---- - -------- fir-- - ----------------(Qyanm=axaNt5r Contractor) By: - ------------ -- ------------------------------------------- (Title)-_ --------------- i I [Plot plan, showing size of lot, ation of system in relation to wells, buildings, etc., can be placed on reverse si r FOR DEPARTMENT USE ONLY - E' APPLICATION ACCEPTED li - DATE ` ---------------------------------------------------- REVIEWED BY------------ ------------ ;it.!\ --- ------------------------------------------------------------------------------ DATE----------------••------- . ---------------------- BUILDING PERMIT ISSUED__________ ______ ---------------•-------------------------...---------------- DATE------tclk-------------------------------------•----------- Alterationsand/or recommendations:---------------- - ---------------•--------- - ----------••------------------------------------•------------ --------------------•-•------------------------- t i _ _ --------- -------------- ------------------ --------------I------ ---------------------------------------- ---- --------------------------------------------•--- ---------------------------------------------------------------- I ------------•--------------------------------------------------- ---------- --------------------------------------------- !----------• ------------------ ------------------------------------•- ----------•------------------------- r [ - t 'FINAL INSPECTION BY:----( _— ------------------------ Date... . f SAN JOAQUIN LOCAL HEALTH DISTRICT.- 60 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California k E`• 9-2M 1454x6 ATWOO. 1Z- 4