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• APPLICA1ION-FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued ...... ___ Appiica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County O dinance No. 549. I JOBADDRESS AND LOCATION------- -- ----- - -------- -- ------------------------------------•-----------------------------------------------••---- Owner's Name--------------I-•---- --------------- Phone--------- -Y--�-.-�---`5-------------------�----�•---- -- Address------- --------- - � - . Contractor's Name----------- •-- Phone__/ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ J Number of living units:,-------- mber of bedrooms _ Number of baths,____ Lot size ----- ----------- e w Water Supply: Public system' Community system ❑ Private .❑ Depth to Water Table - -eft. r of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Charade p - Previous Application Made: Yes ❑ No New Construction: Yes �I leo ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public,,sewer is available within 200 feet.) /� Septic Tank• Distance from nearest wellhl (Distance from foundatison__------Mate�al__\-_% ------------------ _--_-__-.____-. No. of compartments_.. S-ze -----Liquid depth----- ___.-Capacity___ �_rJ - - I ------- Disposal Fi Distance from nears t well_ - -Distance from foundation__�O'__._.._Distance to nearest lot line.9_Q_ __. Number of iines-__/4 --- Length of each line__ _ .._.��._.Width of trench.__ i __.---_-----_-- Type of filter material-;57, Depth of filter material-_/z_______-_Total length______ ________________________ ��/� Distance to nearest lot line_._ __. Seepage Pit: Distance to nearest well/J'.b ___- _!_Distance�rom foun�tion___ ______________ r-y � Lining- inin male,iaL.L---- -��_. '� FrSize: Diameter_____Z'��:.----Depth---_ s _-_�______________ Number of pits_ . .__ _ __e._..-_ g 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):____ __ � -- ---� -- -- e --------------- Y ------ ___ - --- --_•_____ ______ ---- __••_____ ___________________ ` __ ________-______•---------- ---------- - ------------ ----- ------- _ ------------------- _-__._.______.-__..___--_ I hereby certify that I have prepared this application and +hat the work will b one in accordance with San Joaquin County ordinances, State laws and rules and reations of he San Joaqlin Local Health istr' t. �3 (�and/ ontrac+orj (Signed) ------ - - $ --�----- -- - ------- I-� Title ----- (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----- ----=--------------------------------------- APPLICATIONACCEPTED BY-------- -�---- - --- -- �:,��---- --------- ---------------------------------- .� REVIEWEDBY-------------'---------------------- ------- ----------�; -------------------------------- DATE DATE BUILDING PERMIT ISSUED.--------- ------------------- ---•------------------------- �----- -------------------------------------- ----------- - Alterations - ---•--------------------- Alterations and/o eco menciations:-_ ---�._------_.- ." ::� I I Z) CkL4-iL-------------------------------------------------------------------------------------------------- --_--------------- FINALINSPECTION BY:.---82�- ------------------------------------------ Date_---I.-_._ ------------------------•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M 145446 AYWOOD 12-54