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APPLICATION FOR SANITATION PERMIT Permit No.&__4__S. �. (Complete in Duplicate) " !r �' `"' Date Issued V .� µ, Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicati ou is made in compliance with County Or finance No 549. r. JOB ADDRESS AND LO A ION_-_____-,/ - - ' tI .Qz- • �01 Owner's Name p_ _ f -- ---- ---- -------------- ------------------------------------- Phon .e_7_4 V .-------- Address----- i fl --------------------------------•-------•-------------•------------- Contractors �ame----------------••------------------•-- -------------------------------------------------------------------------------------------------- Phone__. ---------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number i of living units: _�____ Number of bedrooms _/ __ Number of baths _�---- Lot size --�-~Q--x- /��----------------------•------- Water Supply Public system J Community system '❑ Private ❑ Depth to Water Tablee-If_- ft. Character of oil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ClLoam _Y, ❑ a y ❑ Clay ❑ Adobe M Hardpan ❑ Previous Appli2ation Made: Yes ❑ No ❑ New Construction: Yes ❑ No EJ TYPE OF INSTALLATION AND SPECIFICATIONS: d (No sep is tank or cesspool permitted if public sewer is available within 200 feet.) �a. W-Via...•., Septic Tank: Distance from nearest well__JT a ------Distance from foundation____-_U-.--___-_.Materia l __ No, of compartments-------- -------------Size__,�t�j c x_', ____----Liquid depth-------' - -----Cap.cty--- ----- ------ Disposal Field: Distance from nearest wer1_6 _-!____._Distance from foundation---/_G_----------Distance to nearest lot line.--4 Number �] Number of lines------J-----------------------__Length of each line___l_ - - Width of trench___-_--J,V_`-.- • 444, _I R--_-____- I--------- Type of filter material---/�4 -A--__-------Depth of filter material----l__�--______-----Total length----- ------------------- Seepage Pit: Distance to nearest well ___----___ ----------Distance from foundation--------------------Distance to nearest lot line__.________.-._ ❑ Number of faits----------------------Lining material-----------------------Size: Diameter------------------------Depth------------------_--------__-- { Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--_-_______-_____-_-_____-_____ >, ❑ I Size: Diameter--------------------------------------Depth--------------------------------------------------- Liquid Capacity----------------------------gals. Privy- Distance from nearest well-------------_-----------------------------------Distance from nearest building----------------------- El Distance to nearest lot line_______________________________________--_ 3r Remodeling an./or repairing (describe):------------------------------------------------------------------------------------------------------------------ ----•- -- ---- ---------•------•--- ---------------------•------ -- -- -------------------- ---------------------------=--------------------------•-----•--------------------.....-------------•----------------------•-----------------------•--------------------------------------••--------------------------------- --------------------------M------------------------------------------------ '--------•---•--------------------------------------------------------------------- ------------------------------------------------------- --- I hereby c%rtify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Stale laws, and rules and regulations o the San Joaquin Local Health District. (Signed) d�dG ------- -------------------------------- ----------------------(Owner and/or Contractor) BY:--------q�---------------------------------------------- �- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Ali �Ipp� FOR DEPARTMENT USE ONLY APPLICATIOP f CCEPTED BY----------------- ------ -- --- I DATE REVIEWED BY-� G� ---- DATE- BUILDING PERMIT ISSUED----------- ----- ------------ -- - - ----------------------- ------- DATE---- --------- ----- -------------- ---- -- Alterations and/ r recommendations------- ---------------------.--- ------------------__-- ------------- --------------------------- -- � ,r,� €? +� _t` -. =-'r v "®°" r =r_----'�--- -------------------------------------- --------------- ------------------------ ---------------------------------------------- --------------------------- ------------------------------------------------------------------ -- FINAL INSPE11 TION BY:-------�!__V�------------ ------------------------ Date U___ / � f "�'' ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton,[alifornia Lodi, California Manteca, California Tracy, California ES-9-2M 5-51 evised W-2100