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44 �. 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 herein described. This application is made in compliance with County Ordinance No. 549. � JOB ADDRESS AND LOCATION 1Z� 9 - ----.S---- �"I"�� - ----------- -----------------------------------------------------------------------------------•-------------- IOwner's Name ' �`�- ---�------ - ---------------------------- - ------- Phone---— ---------- Address------------------- i`r` --------------------------------------- Contractor's Name-------- 4 �------------`-- =--------------------- ------------------------ Phone------------------------- - - ------------------------------------ ----------------------------------- Installation will serve:. Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other G4�,d Number of living units: ---I--- Number of bedrooms _l____ Number of baths __f_-_. Lot size --------- • "'___ -____ _ _^______________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ________ ft. 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 ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)r Septic Tank: Distance from nearest well____SV----Distance from foundation------ -----------Material--- ---------------------------------------------- 2k __C 'L _______________. { f No. of compartments __ __ __Size__ I� p �" ------ 67---�__--�---`��--------Liquid depth---------�-------------Capacity------ Disposal ---- Dis osal Field: Distance from nearest we€l__,7_- .. �_r_______Distance to nearest lot line__5._______ 9 p ---------Distance from foundation______ , Number of lines-------------/_�__t_____�_-____ Length of each line---------------- Width of french___-_____ _____--___.___ Type of filter material-_�/-�,-)- ___:Depth of filter material___J_(—?_---------Total length-----------`47A_r_____-_•__________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line____________.__._. 0 Number�of pits----------------------Lining material----------_------------Size: Diameter-----------------------Dept h-----_-------------------------- Cesspool: Distance from nearest well_________.___--_Distance from foundation--.----------------- material-------------------------------------- ❑ Size: Diameter------------------------ ------Depth--------------------------------------------------Liq6id Capacity-----------------------------gals, 1 Privy: Distance from nearest well________________ _______________________________Distance from nearest building------------.----_-______________________- ❑ Distance to nearest lot line------------------------------------- --------------------------------------------------------- Remodeling and/or repam g (descr-,,'tee):------ '`- ---- -- ----s 2.(- -�--------f � .. a�i.._ _ `!• �-f' _ n_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/atte laws, rulesandregulations of the7San Joaquin Local Health District. { 9 } ------------------------------------------------ ------(Owner and/or Contractor) By:---------------------------------------------------------- ----- (Title)_ ---------------------------------------------- ---------------------------------------------------------------- (Plo+ plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY--------------------- - - ------ ---�_ -------------=----------- DATE----------- -- --- /v."/'-`( - REVIEWEDBY-------------------------------------------- -------------------- --/-- ------------------------------------------- DATE_-------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ------ - _ DATE-------------------------- -- Alterations and/or recommendations------------------------------------------------- -------------------==----------------------------------------------------------------------------------------- ----------------------------- - ----------------------------------------------------------------------------------------------- -------------------- ------------------------------- i � / FINAL INSPECTION BY:- ----w�/ ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California it ES-9-2M 8-S1 Revised W-2100 fj