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1 APPLICATION FOR SANITATION PERMIT Permit NS�_f..7-_.. (Complete in Duplicate) ., bate Issued 3l/�-:3 Application is hereby made to'the SanJoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County QQOrdinance No. 549. JOB ADDRESS AND LOCATION----- C1---------------- C? ---------- Owner's --------Owner's Name-----------C-� Address--------------------(1/-- /.�_.. .......... 1T ---------------------------------------------..---------------------- Contractor's Name - - � ----- ----- N ----------------- --------- --------------- Phone_?: 247 -------- Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms,2_--- Number of baths Lot size _---- _-'_ - -------------------------- Water Supply: Public system Q Community system ❑ Private ❑ Depth to Water Table -------- ft. E Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Haedpan ❑ , Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ 1 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. O&E---_Distance from foundation----/0--- ----.Material__-C_C---13. R 10 No. of com artments--____9-__-_------.--Size- -_,_X. . -�_..__-.-Liquid;depth--� -__Capacity_-��-G_ - i Disposal Field: Distance from nearest well-_ 141plYjFDistance from foundation...`?.CL_- _---.Distance to nearest lot line---�O_--_--� ® .�--;--;----_`_---------Length of each line----_-YlJ---- U----.Width of trench.-----` �/---------------•-• [ �y _ Number of lines......-_._ - VY Type of filter material-"J5--_/P4,A-/(--_Depth of filter mate ria l_-__/- ``.---..---Total length------- ----------------------- Seepage Pit: Distance to nearest•,welL.---___----- '---Distance from foundation----------------- Distance to nearest lot line-----.-.--------- �L ❑ Number of"pits---------------------- Lining material----------------------.Size: Diameter-----------.............Dept h--------------------------------_ r Cesspool: Distance from nearest well-----------------Distance from foundation--- --------------Lining material----------------------------------_- ❑ Size:•Diameter------ --------:----------------------.Depth-------------------------------------- ------- --Liquid Capacity_.------------------------gals. Privy: Distance from nearest well-----------------------------------=-------------Distance from nearest building--_-____--------------_-----.-_-..----... I r ❑ Distance to nearest lot ----------------- ------------------ -•--------------------------------•--------------------------•------------------------ - Remodeling and/or repairing (describe):------------------------ -:------------- ---•-----------------------•--------••-------- ---------------•--••------------------ ----------- ---------------------- --------------------------------------------•-----------------------------------------"---------------------------------...---------------------------------------------------------------------- ------------------------------------------------------------------•---------- -----------------•----------------------•-------••--------------------------- ------------------•------------------------------------------ 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. (Sign ed /� - - -------------------f09iNt420Rrp6F Contractor) By:----- -------------------------------------------------•-------------------------------------(Title)--` frr f-------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY k_ APPLICATION ACCEPTED BY------------ --- -•------ -- --------------------------------------- DATE---------- REVIEWED BY------------------------------------- - - DATE---- - BUILDING PERMIT ISSUED. ---------------------- � I . DATE--------------------------- Alterationsand/or recommendations------ ------------------------ ------ ----------------------------------------------------------------------------•-----------------•------- --•------------- i -•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <, FINAL INSPECTION BY::---- - Date--------- /__ -------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT .51 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100