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�tAPPLICATION FOR SANITATION PERMIT Permit No....SP.J..1.3 l ' (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. This application is made in compliance with County Ordinanc o. 549. JOBADDRESS AN CAff l . S- -�--- ----- ---- -- �--••...-------- ------...---•--•--- -- -------------------------- Owner's Name ------- -----�---------------- -- -- -- -------•-------------------------------- - -------------------------------------Phoney �,-31 Address ......... ----- - ---------- - Contractor's Name..--- ....... ....._----•-------------------- Phone- - --•-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/... Number of bedrooms __- Number of baths . /.._ Lot size -_ - 4�,y_-_X ._................... Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Tablelv_x_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' Hardpan ❑ Previous Application. Made: Yes ❑ No ;< New Construction: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well_? � Distance from foundation ---�--- ----- Material .�t�----------------- AilICAAAQ t � No. of compartments -------../... -.......... Size .---O----------------_-----Liquid depth ---OF - Disposal Capacity Disposal Field: Distance from nearest ell ._ Distance from foundation_o-ld----------- Distance to nearest lot line --- S-------- Number of lines___________ ___________________ _ Length of each line ------------ -36 ------------ Width of trench___._z_y__��_.._._-.-..__--- Type of filter material_.S p 'length fif-/tf. De th of filter mat .:..__3D______________________________ Seepage Pit: Distance to nearest well ---------------------- Distance from foundation ---- ................ Distance to nearest lot line ----------------- 11 Number of pits______________________ Lining material -------------- .------ ..Size: Diameter --------------------- .. Depth .-__-----.____--___-_.-..____--. Cesspool: Distance from nearest well .................Distance from foundation --------- -....__._.Lining material ------------------------------------- F1 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):-- - ----- `3 -r ------- ---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local HQalth District. ($i ned----(--------- "r `�''K't�c".�' 9 )••--• ---------- ---(Ow r and/or Contractor) By--------------------------------------- --------- ---------------- (Plot - ----- (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 APPLICATIONACCEPTED BY --------------------------------------------------------- - & --------------------------- DATE------------ ----------------- REVIEWEDBY ---------------- ---------------------------- -------------------------------------------------------------------------- DATE BUILDING PERMIT PERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE ----- Alterationsand/or recommendations----------------------------------------------.---•-•-----•••---•---••-------..._.....----•---•---•--------•----••••---•......---••-------------•-•---------... ----- ----------------------•-------------•---------...--••--------......----------••---_...------------•------•------------------•--•--------------•••-....------•--------•••-•--•-----••---------•-------••--•-------------- -------------------------------------------------------------------------------------•------------•--•-----------------------.....-------------_.._.........-----------•---•-----------------------------................. -------------------------------------------------------------------------------------------------------------------------------------------------- •••---------.......------....--•------------_...-•-•••-------------•--•--- ---•-------•-------------------------------- ....................................... -------•-••-------------_---_-------------------------._._...------------------------------------------------------------------._... FINAL INSPECTION BY:...................... _/.� `7t Date.... -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California