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u APPLICATION FOR SANITATION PERMIT Permit No. .../.. a (Complete in Duplicate) Date Issued SG 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 CountyOrdinanceNo. 549. I JOB ADDRESS AN LOCATION--- 5�' Owner's Name ------------------------ - ----------------- ---- --= - one------ Ph ---- Address-------- - .h.f..-..--.----•------------------------------------------------------------------- ------------------------------------ Contractor's Name---- - ./y.-Q. .L, ., ...-.. �`------------- --------------------- -------------------------------------------- Phone Installation will serve: . Residence If' Ararfment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �+ Number of living units: .. Number of bedrooms_?_ Number of baths --'Z- Lot size .- ..--- -"..�., �_ ?_d_ --____-_-_- --_ �= Water Supply: Public system Er-6ommunity system ❑' Private ❑ Depth to'Water Table _0_9ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel-E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[9—Hardpan ❑ Previous Application Madel Yes ❑ No E3---New Construction: Yes [�]--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.Nta&� Distance from foundation---40..........Material_..�� .�1-C-f( ------ No. of compartments----- --tr�.�.C�...Size--- ..-•-----f- - --Liquid depth-------L+_ ?-.. L`. -.--__--Capacity.__ ,.--•----------- Disposal ,field: Distance from nearest well ...✓�.. Distance from foundation.... ....p......S7istance to nearest lot line--- —ine_.. ....._---- Number of lines.-------/�... - --'-_---Length of each line...--- - - .--��' S/ X _ Width of trench_.............. i _ ----------------- Type of filter material__ ... _ -__Depth of fil rial_.-..�. ..�.-_.Total length--------- -------------�----- Seepa it: Distance to nearest well_./kjQ:.�.�.Dis ce from foun at __J�d--------Distanfre to nearest lot line.....------- Number of pits-------./------------Lining m eriaLA.�r_�r_-Si Diameter---;.�-�--------__--Depth__.-_v�3_-'--•- Cesspool: Distance from -nearest well----------- -- -Distance. p rom oundation.-'--'-'----------.Lining material---'----'---------------•-------____- Size: Diameter____-____'-'------'--------------___-De th...•'-'.-___ _ -Liquid Capacity gals. D ❑ p q p y------------•--------------- Privy: Distance from nearest well--------------- ----------------------- -----Dsstance from nearest building....----_-------._.__._____----------- Distance to nearest lot line--------- ------------------•--- -- RemodRemodeling- eling and/or repairing (describe):-------/Y_e,_L<,_)----------.t ._l--1 E` -I------------------------•-_ ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- -- --------------------------- -•--------•----------------------------------•-------------------------------------------------------•---------------------•---••- ----------------------•---------------------•----------------- I hereby certify that I�'have prepared this application and that the work will,6e done in accordance with San Joaquin County ordinances, St s, and rules and regulations of the San Joaquin Local Health District. ' ' „ er and/or Contractor)---�.---- -- - - --------------- (Title)---gy: -------- (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 APPLICATION ACCEPTED BY----- ----------------- ---- ------ DATE----- REVIEWED BY------------------- - --' --- ---- - -------- ------------------------- DATE--.-- ISSUED ATE BUILDING PERMIT ISSUED. -• ------- -------------------------------------------- DATE----- s Alterations and/or recommendations-------------------------- --- ---- --- - --- -----------.----------------------------------------=-----•-' - - - ----- - -= ' ' ---- -------------••------ . --------------------- ------ ----• •----------- E -...-.....[.................................... ......... .. -----------------.------------------------........---------------------------------------------------------------------..--------------------------------- FINAL INSPECTION BY::. r -Date.. ------------------ T' e SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfrset� 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-8 145446 AT-D '-� _