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7 � APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) . •�..,�. ,.:r G Date Issued . 1---- 4- s Applica4-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.44. JOB ADDRESS AND LOCATION______________�._1_6 a AJ ' �'�'�_'` t�.��l __. ------------- V --------------------------------------- Owner's Name S ---- Phone------------------------------------ Address �!'--�t. -------------- I - •---- ------ � = - C Contractors Name ti +-, £'-��•------- Phone Installation will serve: Residence artment F�use� Commerc;al Trailer Court El Motel 0 Other Number of living units: _ ___ Number of bedrooms ________ Number of baths Z____ Lot size ________� _ �_ s� ------------------------------- r Water Supply: Public system` ommunity system ❑ Private ❑ Depth to Water Table -------- ft. i Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeLL—Hardpan ❑ Previous Application Made: Yes ❑- No [�.rPd�Construction: Yes k]—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest welL_.-----------------Distance�fio oundation____________________Material_______._._____________..______----------------No. of compartments Size fix .. Liquid depth- Capacity... Dis _ field: Distance from nearest well_________ Distance from foundation--------------------Distance to nearest lot line_:____....__.__. � i� Number of lines-----`..............................Length of each line-------------------------------Width of trench.---_----------------------------- Type or filter material................... .. ..Depth of filter maierial-_-.____-_..__._...___.Total lengfih___._ti__:_-______-_____________________ o Seepage Pit: Distance to nearest well__+ _ _____Distance om f undation_tAd Distance to nearest lot line_._�?-__��s. Y,. Number of pits.- ----- -----U ng material--- 1f.! --Size: Diame er.___- 'T' ----.Depth. ------ ______________ Cesspool: . Distance from nearest well-----------------Distance from foundation.-------------------Lining material--------_____-------_-______________. � . k ❑ Size:.Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------_------------_----Distance from nearest building----------_------------------------------. 1�\ * ❑ r. Distance'to nearest lot line-- ----------- -------------- --- --------------------------------- ------------------------------------------------------------------ Q Remodeling and/or repairing describe :_ -------- ------- -----•---- -------------- ------- d c ------ ------___-• r V1 g.f 1 - --•----------------•-----------•-----�--•------' `_ ------- -------------------- i --------------- --------------------------------------------------- ------------------------------------------- --------------------------------------- -----------------•---------------------------------------------------------------------------------------------------- --------------- --------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staleend rules ar0A#A*M Hf the San Joaquin Local Health District. r Septic rank Servic9 5i ned __:__I�O6_So.#tdorado---HO.2 704 = (gner.and/or Contrae( 9 } Stockton Calif. BY=-------------------- ;= --;- -- -- -----(Title}-------- ' �--: r---------•--- -•------ ------------------- ----------------------------------------- ------------ �=---- ------------------ (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------:'�'Ag..� -------------------- REVIEWEDBY-----=--------------------------------- --- -------------- -----------------------•------ --------------------------------- DATE---------------------------------------------.......---- BUILDING PERMIT ISSUED------------------------------- ---------------------------------------------------------------------. DATE------------------------------ --------------------- Alterations and/or recommendations---- ------ --- ------- ------ --------------------------------------- ------------------ ------------------------------------------ t- --------------------------- �= - ---------------------------------------------•---------------------------- ------------------------- = ------ -----•----•--------------------'--------`--------- --------------------------------------------------=-----------'- -------------------------------------- --------=---------------- -------------------------------- FINAL INSPECTION BY------------- -- - - Date----�-- --- --- { -- ------- ------ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M 145445 FTWOU- 12-sq