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------- -- ------- APPLICATION FOR SANITATION PERMIT Permit No. ----- ---------- -------- - --------- ------------- --- (Complete in Duplicate) --------- ------------ --------------------- ------ This Permit Expires 1 Year From Date issued Date Issued Application 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 wifh County Ordinance No. 549. JOB ADDRESS AND LOCATION- .__ �/ a Owner's Name_----__ -------- Phone ---------- - - -- -------- ---------•� --------------------- -••-•------------------------------------ Contractor's Name____________ ___ ---_----A_--- - - � - - ----------------------- Phone Installation will serve: Residence [?!r"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: _J_._ Number of bedrooms - Number of baths _ ----- Lot siie __F OJC/ D -------------------------- Water Supply: Public system R-tommunity system ❑ Private ❑ Depth to Water Table _4'a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan Previous Application Made: (If yes,date-. ._.._..___.------) No e, New Construction: Yes ❑ No �„f IA/VA: Yes ❑ ,t No TYPE OF INSTALLATION AND SPECIFICATIONS: ®' (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) i Septic T1 rik: Distance _from nearest well---- ------Distance from foundationJp_-_____.__.Material__-_/ --____.___,-:--_-- No. of compartments_... -_ X ------- - Size 1� Liquid depth--. - Capacity '00 Dispos 1 Fie Distance from nearest well-----------------Distance from foundation-------------- to nearest lot (ine___r-________._. Number of lines------.---'-------------------`--_Length of each line_ ----`-- -------------.Width of trench--_----:------ ::- Type of filter material___________________ Depth of filter material- ___4_. _- _7total 'Number of its rematerial , _ = _ Seep e P't• Distance to nearest well_____________________Distance from foundation________________.Distance-to-n`ea"resfi�-Iat line__._____-�._____ _ y p Distance from nearest-well------------------Lining material__- __-Size: ,Dia�meter.-;---------------'.---Depth --- p Cess ool: Distance from foundation ____________Lining material_____.___-----_-_-----_- 5ize. Diameter - =------------------ ------Depth--------- -----------------------.- ------------Liquid Capacity---------------------------gals. Priv i Y Distance from nearest well____________________ ante from nearest buil&n Tn 3 -.Distance 9 ------------ ------ ❑ � Distance to nearest lot ii_ne___________________ ___ - C --- ----------- ---------------------•----------•----------------------------- ----------------- G Remodeling and/or repairing (describe):_- __ --_ u -------------------------- ------------ b ---------------•------------------------------------------------------ ------:---------------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in-accordance with San Joaquin County, ordinances, State laws, and rules and regulations of the Sari Joaquin Local Health District. ned (Si g ) M" --- T ------------------------ ----------------Pwff2r`-" By:---------------------------------•--- ` - = or Contractor] ---- ------ - - --- --------------- --- --------------(Title)---------------------- -------------------- (Plot plan, showing size of lot,1-0cation of system in relation to.wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_- - -------.. �F -'--�...f> c ------- - DATE_.._ _ REVIEWED BY - :=,.: �� __2. __. . BUTO NG PERMIT=-ISSUED - ---------- PATE ----------------------------------- --------------------------------------- DATE Alterations-and/or recommendations:-------- ...:----__ - -------------•-------------- -------- ---------------------------------------------------------- ---------------------------- FWAL INSPECTION BY_ / ---=------ Date_...1�� - ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O.