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�3�f APPLICATION FOR SANITATION PERMIT Permit No. { (Complete in Duplicate) j . y� Date Issued ,.pplica+ion is hereby made to the-San Joaquin Local Health District for a permit to construct and install the work herein described. This a plication is made in compliance with County Ordinance No. 549. Qp,s .. 2?n CG t. ... _..--. r•- JOB ADDRESS AND LOCATION...• • t '�i1'k� �,P`��Gf ..... .._.k -. ...................................... Owner's Name....R.-Aj"1 ._.._/�.. ....................••--....-•---....-•••-•.............---._.... Phone.............•-----_----_-- - Address_. - z-.... --_-•--•-•--•- ....................•-----.........•-•-----•-----•--- ------......_•-----•-•--•-----•-•---._....__...-----...... -_-------- Contractor's Name...�.................--------------------...........................------------------.._..._...----------................... Phone................_................. Installation-will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court C3Motel ❑ Other ❑ _ _ .'Number of living units: .4..... Number or bedrooms -__.-Number of baths/_.__.. Lot size - -••-_•--------------- i Water Supply: Public system'[E Community system ❑ Private ❑ Depth to Water Table ........ ft. +11 Character of soil to a depth of 3 feet! Sand ❑ Gravel ❑ Sandy Loam® Clay Loam[I Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes❑ 'No R] 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...r M�.�..Dista from foundation. ..............Materia..._._,_.......___._.__....._. > ............... .................. ...........Liquidacit ._� ........._. p sal Field: Distance from nearest well_-�d:'_...._Distance from founciation_319...........Distance to nearest lot line..,.._....... Number of lines_.... -..___._._:. Length of each line-.. D.'.,... -_.Width of trench__.0 ..'..................... Disposal o p�N Total len th._�p .. ..-••....................... Type of filter material,/ ....Depth of sitter mater;a!_..�er._..._.. g Seepage Pit: Distance to nearest wail......................Distance from foundation....................Distance to nearest lot line............... , ❑ Number of pits:;._...---_-•--.._Lining material............. ..........Size: Diameter..............._.......Depth--.--.-.--.-----___---_--__._-!`j,� Cesspool: Distance from nearest well.................Distance from foundation....................Lining material.................................._. El Size; Diameter....°J...................••••-...... ...••. - Depth .........-----....._-._._....Liquid Capacity............................gal : .l Privy: Distance from nearest well---------........................................Distancd from nearest building..........................__-_._......� ,. [] •- Distance'to nearest lot line--------.......................__.:..----•-------•-•---....---•--•--.._w_.._......_..._..._.._._..--•----...-•--•-••--••---.....-----•---• _i Remodeling and/or repairing (describe):....................... - ...........................................•-•---------•------•-•-------• --..._..------------•----••-----•_.----•---------- �l •-•---•-••---•-----------•••----....•.....................................•-•-•••---•••--••----_....._.........------... ' ...................................................... ......•_-__....-•---...._._..................._.............._....-•----•--•-•. --...-•--•-----------•---•---....--.------.... 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 Health District. t (Signed) '_ ... ...............................................=..............................{Owner and/or Contractor) . itle-_--------_-_------_- ..................•••....... -(Plot-pIan;=showing size of lot, locatiori`of•system in-relation'fo wells;buildings 'etc:;can-be`pl c@d'bt1'reverse silo}""" a FOR DEPARTMENT USE ONLY .--. DATE._.y_�. - ................................ APPLICATIONACCEPTED BY_.. ............ .. .............•----......_..-•--•-•.............................. REVIEWEDBY......................................... .................._.........__.............................. DATE_.........---......--------- --_-_--------._----•-•--•- BUILDINGPERMIT ISSUED..............................................,---..................------••••---••----••------.---- DATE. ---------•--------------•--••----•----•---- Alterationsand/or recommendations:............... ..................................................•............................................................. ...........-..._--•--•--- --•-----•--..............................................---------•••.......................................••--•-......-•--•...•........................... .......................... •--•........................................••...••-••-••-••••..._--••••-_._......••-•••••-••-----•-..-..........••--•---...••••- ••..............................••...._•-•-_...-•-••••----••--•-••-•.............-••-•-•••-•-•.........-•••••-•-•-.......•••--....:....................-•-..........•-----..._.. ....... ........--••--........._.......-• :...... ... -••-.....:........ _...-.1.......... ........... .......... ----------------- ... FINAL 'INSPECTION BY:.... . .... .. . . . •••-- Date..�.�:_'.- O 's 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 Efr-•9 14545 A-.W000