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-7 APPLICATION FOR SANITATION PERMIT Permit No. 28 8------------- lY Z / - Z (Complete in Duplicate) 7--25--'-5-2 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION.._-_ �__ .� - I, r Owner's Name---------------------` �' --- 72ti ------------------------------ -------- --------------------------------- Phone-. ---�-------------------------------- ' ----- ------- Address-__-----------------------------••-----------------------------__••------------------ ----------- -----•- Contractor's Name_------------------------------------------------------------------------------------------------------------------------------------------- Phone--------`---------------•-------- .t R . Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _______ Number of bedrooms __z _ Number of baths I---- Lot size ____________________________ r Water Supply: Public system ❑ Community system ❑ Private P Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam 'Clay Adobe Hardpan P ❑ ❑ Y ❑ Y ❑ ❑ ,,� P ❑ Previous Application Made: Yes ❑ No�K New Construction: Yes No ❑ ,\ i TYPE OF INSTALLATION AND SPECIFICATIONS: ` t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_- C?_-----Distance from foundation------10_`q___.MateriaI------ � ------- No. of compartments------------- .. -_.Size---- x-9_�C_-�-----Liquid 'depth---------4/-_iQ........Capacity-------eg_!;7---- Dispos I Field: Distance from nearest well--� __._.Distance from foundation_____�Q---------Distance to.nearest lot line-------x Number of lines______________�_________________Length of each line___________ r '' ' ...�}, _ �0---'------.Width of trench_ -�-_C�--=---------------=- Type of filter material____-1"-�r�___-Depth of filter material----------l�--_____Total length_______________�_ZQ-------------- Seepage -----.---..._-_ Seepage Pit: Distance to nearest well----------------------Distance from foundation.....................Distance to nearest lot line______,__:_______ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------------- Cesspool: ----------__---------•-,----- Cesspool: Distance from nearest well_________________Distance from foundation-.------------------- Lining materia)___________________-_______-__-. i Size: Diameter--------------------------------------De th-----------•--------- ------------------------Liquid Capacity --gals. Privy: Distance from nearest well------------------------------------------------- from nearest building__________________-_•_-_._-_•_-____-____-- ❑ Distance to nearest lot line-----------------------------------------------------------------------------•---------------------------------- Remodeling and/or repairing (describe):------------------------------------------------......--•------------------------•------------------------------------------=--,-----•----.....---• ---------------------------------------------------------------------------------------------------------------------------- -------•----------------------------------•--------------------•-•---------------------•-----------------------------•---•--=-•--•---------••-----•- ------------------------------•-------•---------------------------- k ---------------------------------------------------------------------------•--•---...------------------------------------------------------------------------I-------------•- --_...---------------------------- --------------------------------------------------------------------------•------•---------... -----------------------------------------•--------•---------------------------------•------•-•-------•--------------------- ti ! 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)---rf -- ------------------------•----------------------------------------------------(Owner and/or Contractor). By-----------------•------------------------------------------------------------------------------------------ ------------------------(Title)----------------------------------------=-------- ------ y (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t I FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY------•- - ------------ ---------------•---------------------- DATE------------- .. � ��-y--------------- REVIEWED BY--------------- --------------- -:--------------------- ------------------- DATE--------------------------------------------------------- ` BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------ r Alterations and/or recommendations---------------------------------------------------I---------------------------------- ---------------------------------------------.. -------------•--•-------- ---------------------- ---------•----------------------------------------------------------•---------------------------------•------------------- ----------- -----------•- ---- -•------------------------------------- ----------------------- ---- - --------------- FINAL INSPECTION BY---------------- ----- ---- Date--------- ----- f F SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+reef 132 Sycamore Street 814 North "C" Street H Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100