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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) VI/ Date Issued --- t ,�3—.,3 Aplica-%in is hereby made to the San Joaquin Local Health District for a permit to construct.and install the work herei scribed.00-1 lo This application is made in compliance with County Ordinance No. 549. -1— ---------- - SV JOB ADDRESS AND LOC iO�N_ --------4 -------------- Z --------------- Phone--------------------•----- Address--• o er--------------------------------- Owner's Name---- ri.-I--- ----------------------------------- h n Address... ...........................--------------------------------------------------------- ------------------------------------------- Contractor's Name------ --- ---------------------- Phone. -- -------- I Installation will serve: Residence J' Apartment House E] Commercial 0 Trailer Court ❑ Motel E] Other ❑ Number of living units: -/-- Number of bedrooms Number of baths --- Lot size ------------------------- Water Supply: Public system El Community system [:] Private Depth to Water Table-OW_ ff. Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam FrClay Loam E] Clay F] Adobe El Hardpan 0 Previous Application Made: Yes 0 No E' Now Construction: Yes ®-No E] 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-_OT------Distance from foundation---AQ..------- Material._.- ------- Er- -- 'No. of compartments-----roti1�1................Size- ------I- --A V--- _.- ----4(a ----Liquid clepth___�/_-4 .........Capacity--- Disposal Field: Distance from nearest well... ...Distance from founclafion-__120-11.....Distance to nearest lot line----4< ------------- Number of lines------------/... of trench---of each ,`..•..........Width h___j�_IKOI o __ - - ---------------- Type of filter material. Depth of filter material------f47---- Total length-..-.-.7t i------------------------ Seepage Pit: Distance to nearest well----------------_---Distance from foundation--------------------Distance to nearest lot line----------------- 0 Number of pits----------------------Lining materia;---------------------..Size: Diameter-------..-----.--------Depth--------------------------------- Cesspool: epth- -- - -------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---.--_...-.-_-.-- Lining material-.--....-------------_--------...._. El Size: Diameter--------------------------------------Depth------------ ---------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ 0 Distance to nearest lot line Remodeling and/or repairing (describe):-- ------------------------------------•------------I-------------------------- --------------------------------------------------------------------------------------------------------------- -- ------------------------------------------------------------------------------------------------- --------------------------- --------------------------------------------------------------I-------------------------------------------------------------------------------I—------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------_-------------------------------------------- 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. (Signed -- - - ------------ -- - -- - -- ------ -------- ------------------ ------------------------- Contractorl By:---------------------- - -------------- ----------------------------------------------(Title)-- Z_,V4 ---- ---------------- (Plot plan, showing size�4-rioca�i-o-n-of system in relation to wells, buildings, etc., can be placed on reWrse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY� - ------------- -----------*------------*--------------- DATE.!?2�---------------------------------------------------- __ . - __----- -- -------- - -------- -------- -------------------------------------- DATE----t----------------------- REVIEWED BY-------------------------------t BUILDING PERMIT ISSUED------------ ------------ ------------------------------------------------------------ DATE-----1��----------------------------------------------- ---------- Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------lu - .------------------------- -------------- ---------------------------------------------------------------------------------------------------------------I---------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------I-------- -- -------- •----------------------------- -------------------------------------------------------------------------------------------------------- ------------------------- ----------- -- ------- .. ..... . ------------------------------------------------------------------------------------------------------------------------------- 10", - FINAL INSPECTION SY]: _k -- ---- -------- Date...... "' /, - ---W- W- ------------------------------------------ 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