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APPLICATION FOR SANITATION PERMIT. Permit No. (Complete in Duplicate) G� D - � ate Issued pplicafioh is hereby made to the.San Joaquin Local Health District fora permit to con This application is made in compliance with County Ordinance No. 549, construct and 'n Il t e w'ep•rk h rein described, JOB'- DDRESS AND LOCAT ONd 2(ft f ----- ----�--�---- - Owner's Name_ * ' ------- ,_ � - - - -- -'AlY -� - - ------------------ Phone- e Address_---• -- _ _-- - --- ------ ----------- ---- ----•----- - ----------------------------------- ontractor's Name_-__ _ - s � ----------------- -- -- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot?] ❑ Other f❑ Number of living units: __�-__ Number of bedrooms _ / ^� y / �^�- Number of baths -_f---_ Lot size _"'�0 "f Ste? Water Supply; Public system �Communit system� Y Y ❑ Private ❑ Depth to Water Table -------- ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam [] Clay Loam Clay �� Previous Application Made: Yes ❑ No � New Construction: Yes No ❑ ❑ Adobe L Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ ( 1 (No septic tank or cesspool Permitted if publir�sewer is available within 200 feet.) ,r Septic ank: Distance from nearest well4p-----_ --Dist ce fro ffou _ )ion-____��--__--.Mate ' I__P__�_Cr�a�cify f No. of compartments.---_-----:- Size -- -------1-- � x - es-- - ----Liquid depth----------,-Dispos a'Field: Distance from nearest w II n--__ _,Distance from foundation___!_�_I�e nearerlofj y__ pistance to nearest lot m �,__ Number of lines-------- � gg- �.�.....�,.+ Lengfn of each line------ _--- - Ar_-.----Width of french---- Y" s Type of fitter materi�--____r�---�---- of filter material-__l_9___ - {------ ------ Seepage Pit: Distance to nearest well=.-.-_ =______ Total length r ---------------- e ---------- - Distance from foundation----,_ Distance to nearest lot line_;___— _ ❑ Number of pitsDistance material_------__--- r -----------Size: Diameter-------•----------------Depth---------------- Cess ----------------- Cesspool: _ S p Distance from nearest well-------------------___ Distance from foundation__-----____- _Lining mafierial------------------ � � m ❑ Size: Diameter----I----- ---- --- -------- ------Depth ---------------- -------- ----- ---------.--------- 1 -----------------Liquid CapacifY---------- ----- Priv :. ElY Distance from nearest well---------------------- ..........................Distance' from nearest building Distance to nearest lof line --------------------------- ---- Remodeling and/or repairing (describe);----------------------------------------- ------------- � - -------------------------------------- ----------------------•------------------------------------------------------- --------------------- -------•-•---------------------------- -----------------------------------------------•---------------------- - --- -- ti -- I - --- -- -----------------------------hereby certify that I have prepared this application and fhat the work will be done in accordance with San Joaquin County ordinances, ate laws, a d . les and ,regu ations of the San Joaquin Local Health Dis+ricf. (Signed)--_-- ---- --- -- ----- ---------------------------------------------------------------------------------------------- By. (Owner and/or Contractor) ------------------------------------ - -- (Title} (Plot pla sh6wing size of lot, Iota+ionof system in relation to wells, buildings, etc., can be placed on reverse-'side)- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-0------ I --___-_ —--,_ ---------- DATE-5-- REVIEWED BY ' - ------- BUILDING PERMIT ISSUED ------ DATE ---- =''= ---------- - �- . ----------------------------------------------- Alterations and/or recommendations---- -------------- DATE_---__ _-- ------- -----_ �. ---- ----------- ------------------ ------------------------ ---------•---------- ------- ------- --------- - iFINAL ----------- ------�-�------- -J-_-_-�------_---�--- � -------------- a INSPECTION BY. ---- - -------- ------------------ Date-- --- -�O------ ----- -----------------� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lod814 North "C" Streat Lodi, California - _ Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100