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APPLICATION FOR SANITATION PERMIT Permit No. ... •-_ Cpl} t9/ - (Complete in Duplicate) Date Issued _____/A?0 0 n,V Applica-�ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her ain described. This application is made in compliance with County Ordinance 549. -11 . /� _...JOB ADDRESS AN LOCATIONQ Phon e------------------------------------ Owners Ne rw,. – - .... Address----!. ---------- _ .._ � ,Cr�i... .. r �-�.. --- ---------- ---------- Contractor's Name Installation will serve: Residence partment House ❑ Commercial ❑ Trailer: Court ❑ Motel ❑ Other ❑ Number of living units: __.I_--.Number of bedrooms -:Z-- Number of baths .-I-___ Lot size ----' ,f---- _..�- -'L�,-------•----------- Water Supply: Public system ❑ Community system ❑ Private ?4--Depth to Water Table4e). ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ l-. ew Construction: Yes ❑ No TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer lis-available within 200 feet.) Septic Ta : Distance from nearest well-- -__.____`_-___Distance from foundation_____________I-----Material________.__.____---_-,._________..._-___--____. No. of compartments-------- -------------Size---------------•----------------Liquid/depth--------------------------Capacity--•-------------------- isposal Fie Distance from nearest well., 0- ------Distance from foundation-___,/-4_�....Qistance to nearest lot line._.- __�__.. - Number of lines----------/--------- - -------Length of each line----- - �-------._.Width of trench---- - -------- - ----------------- Type of filter material-___- --------Depth of filter mat erial____.�j_--�_----Total length_____4� -•----_------------------- See pa e Pit: Distance to nearest well_ "•_____Distance from foundation___.__ __ I ��_�_..Distance to nearest lot fine_<__�____._.__ . I ------------------- Number of pits---:= =--------------Lining material_ .c --..Size: Diameter_-. -` --------.Deptn_._ -"r--- {� I Cesspool: Distance from nearest well_________.:.-Distance from foundation------------__-------Lining material--------------------------------------- ❑ Size: Diameter---- ----------- --------- Depth---------------------------------------------------Liquid Capacity--------.-------------------gals. Privy. Distance from nearest well__. -.,_ -_- ------------------------------------------ _ Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line------------------ - --------••--------------------------------------------------=------------ ---------- Remodeling and/or repairing (describe):----- ------------------------------------- -------•---------------------------------------...----------------------------------------------------.-. --------------------------•-------u------•---•--•-------------------•---------•-------------------------- J I hereby certify that 1 have prepared this application and that the work will be done'in accordance with San Joaquin County. ordinances, to I s, and s�andgulations f the San Joaquin Local Health District. =f , i . -fit F'------------------ ------------------- --- ontractorl (Signed)- -Iff- = r By: � �rf' ------{Title)--- (Piot 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 ~y� 4 REVIEWED BY--------------------------------- ----- -- BUILDING PERMIT ISSUED-----------------------•------- --- - -------------•------- ----------------- DATE_ k ----------------- DATE---- --------------------_ " - ...--------- Alterations and/or recommendations:-------------- ----- = ---------------------------------•---••------------------- ------t� _�--------------------- - ( -------------------- •------------------------------------------------ ----------------------------------------------------------•-------------------- -------------------- - -----:-------------"----------------- -- -------------------------------- ----- --------------- FINAL INSPECTION tY:-- --- ----------- -- ---_-- -------------------• Date--- --------4'__0------------------------ •--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 932 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Er • E5—�9-2M 145446 ATWDDD 12 5a