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APPLICATION FOR SANITATION PERMIT Permit No. . (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work��n desc bed. This application is made in compliance with County Ordinance No. 549. - � JOB ADDRESS AND LOCATION_ Tl-- "` -: - ✓ . r-' Owner's Name_ r_ -------------- �-� �'.: 1, -- ------ Phone � Address---------------- , -- ---------------- --- Contractor's Name-- = W •� ---`------ --- �{`�. --------- Phone.-_.- Q Installation will serve: Residence Apent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. -- Number of living units: -------- Number of bedrooms -------- Number of baths ---- Lot size F Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 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 F!t�No [❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T.nk: Distance from nearest well-_A6_t4_C3_Distance from foundation__1�..........Material--- GFAP No. of compartments_�-------------------- �>----Lie{uid depth__.,� '��---------Capacity-- � Disposal Field: Distance from nearest well- -.__Distance rom foundation---- 0_'-----Distance to nearest lot line------- ---� Number of lines-__--,Et_- --------------------Length of each line -" --------------Width of trench.-=-7 Type of filter material _ ,- _--Depth of filter material_--r �'__--Total length-------_- _Q'-------____ Seepage Pit: Distance to nearest well---WDV-,IL_----Distance from foundation---.--- -�--.Distance ---t--o neare-s-t lot line------. -----Number of pits-----/-_.----------Lining maternal---Rack-----.Size: Dameter- ~-`------------- Cesspool: Distance from nearest weft------__-------Distance from foundation-------------------.Lining material -1 Size: Diameter--------------------------------------Depth------------------------------ ----------------- Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot fire----______---____.-_ Remodeling and repairing /or -------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------I------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws and rules and regulations of theSan Joaquin �Local `Health .District. (Signed} -%Y.'jq-!r', `- - --; --- {Uwiea �r Contractor) By:------------------------------------ ---- - - k�a-r �. '_!.? -----(Title)------•-------------- - --------------------------------- --- ------------------------------------------ (Plot plan, showing size of lot, location of system in relation ` , ells, buildings, can be placed on reverse side). FOR DEPART �M �ENT USE ONLY APPLICATION ACCEPTED BY-' 1-l- "r � r-j---------------------- DATIA_R-,O----10_x--a(±_�-5 REVIEWEDBY --------------- -------------------- -----------------.. DATE_----------------- UILDiNGPERMIT ISSUED---------------------------------------------------------------- -- -----------------. DATE -- -------------- Alterations and/or recmendat' ns:-------------- -------------------------------------------------------•-- -------- - - --------------------------- `r._ -- r - -----------O X------ 7_=��Q_- ------- -------•-- ---------- FINAL INSPECTIOtd--B�. _ f�-- - - --------- - ----- -- ---- ---- ---- 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 E5--9-2M . Reviseo 1.57 F.P.cO.