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'1 APPLICATION FOR SANITATION PERMIT Permit No. -..8-`f • --• !1- ' (Complete in Duplicate) pate Issued } Applica''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. 549. JOB ADDRESS AND LOCATION-_ _ ---SJ-- - .sem • :................. . Phone.................. ----- ---___ Owner's Name---- 1� .,• --- -• _ Address.- A • -- :... o^ � �J �(• Contractor's Name_--- __-- ------ ---- -- -- Installation will serve: Residence Apartment House ❑ Commercial ❑- Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __._ Number of bedrooms -Plumber of baths ---Y _ Lot size ________________ Water Supply: Public system ZIfCommunity system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Loam ❑ Clay Loam E3 Clay E] Adobe Q Hardpan [ Previous Application Made: Yes ❑ No V._New Construction: Yes K No ❑ " TYPE OF INSTALLATION AND SPECIFICATIONS: ,(No septic tank ori esspool permitted if public sewer is available within 200 feet.) Septic Ta k- e from nearest well---------- Distance from foundation...-. Material--_-_______________________________________ No. compartments Size = Liquid depth..-.. -.Capacity.............. .... ❑ __...- Disposal Field: ' istance from nearest well--------------- from foundation.____._._._-__....-.Distance to nearest lot line_._...._..____ ❑ ber of lines.----------------------------------Length of each line_:-------•-•••------; ' Width of french ype of filter material________________________Depth of filter material......... ............-Total length------------------------------------- S7istance from foun ation___�v_____..Distance to nearest lot cine- --- Seepage Pit: Distance to nearest well 1 - /�¢� �ze: Diameter------ .o ( Depth. 1.�� Number of pits__/---------------Lining maters __ ` .- Distance from nearest well-- --------------Distance from foundation_-- ___.-__,_--- Lining material.-....:--__-__......-............ Cesspool: Li uid Capacity --91 ❑ q P Y size:'Diameter--------------------------•----- ---Depth = .. Distance from nearest yrell.__.---..-.....:.:............ .--Distance from nearest building---------------------------•----•_-__ Privy: x ... ti ❑ Distance to nearest lot line.................................................................. - --•-••---•-------- Remodeling and/or repairing (describe)_..._______________________________ -... .......................................... --------•---- --------------•--__..._._..---•----------•----•--••---••----••---•-_. -----.._..-•..................•--•---•-•-------- ...--•••.......................•------•-•----------.........................................................:--------- ---------•----------•-• - •-- ................. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou ordinanceyStafeand rules and regulations of the San Joaquin Local Health District. ---- - --- ---- ------•••---------------. -....------- -- er an r Contrac (Signed)--- -------- ) --. .(Title)....- -- =- ----- g Y .(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 DATE---- - ...........---------•--- r\PPLICATION ACCEPTED BY_........ -------------------- ... - - DATE__.._ . :- � ------•-------••-----------•--•- REVIEWED BY .--- - = AT DE BUILDING PERMIT ISSUED __ - ------ - ---------- - r Alterations and/or recommendations:......::....... . • -- r ......................... t - ------ ................. FI 'AL INSPECTION BY:.::. -- _-= -• ----••-•••••. SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 Wast Oak Street Trac California Stockton, California Lodi, California Manteca, California y