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APPLICATION FOR 'SANITATION PERMITJ,�( _Permit,No. - :t.4 -- (Complete in Duplicate) Date Issued pplica*ion 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 LOCATI N-------- /--------- YE.y�- 4---r� ----------f- -----------•---•- ----- -------------,--*---•---- --------••-- Owner's Name f jC9 ---------------------------------------------- - Phone----•-- -- --��--�--• Address --Z `` Y.-f U �e--------------- t � n ------------------------------------------- ---•--... Contractor's Name -------------------------------------------- -------------------- ----- ------------ Phone------------------------ -------- Installation will serve: Residence ,Apartment House ❑ Commercial ❑ Trailer Court 'D Motet ❑ Other ❑ m ' Number of living units: -Number of bedrooms _a__-Number of baths _____I_ 'Lot size Water Supply: Public system JCommunity system'❑ Private ❑ Depth'to Water Table ------- ft. r Character of soil to a depth of 3 feet: Sand Gravel ❑ 'Sandy Loam ❑ Clay Loamr❑ Cay E]' Adobe Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes No ❑ ' � y it 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 wel .f__Distance from foundation-l_0--------._-.Mat rial____:�C. __�A?4_g�_(�________.. No. of compartments . __-_-_.Size__ +� p ` Liquid depth =CapautY ��• Disposal Fie?d: Distance from nearest well__�_C'_(.._Distance-from foundation---1_0---�:.___.Distance to nearest lot line__ > }K Number of lines___._`---_---------------------Length,of each hne...... ___-_--_.-`_'. Width of.trench---_')—'_�---,`�---- - -__ ` Type of filter material_51��_____-:-. : ) _�� _____Total length---f_ _ e t. of filter material____.- C, eepage Pit: Distance to nearest we _______________ __ istance,from foundation---..........__ .Distance to nearest lot line_:--________.._ ❑ Number of pits------- ------Lining material- --------'-.1-.Size: Diameter-----------------------Depth--_---.-------------------------- Cesspool: Distance from nearest well____---- .!Distance from foundation_____________ __ __Lining material______--__.--__..____.______________. ❑ Size: Diameter--------i-----------------------s----Dep h_f---,;;----s.I----------- _Liquid Capacity------------------_:_-------gals . Privy. Distance from nearest well----------------------------------- _,__________________________ -A_-.------- '__Distance from nearest building____-___ _ _____.______-_--.______________ - {❑ -Distance-to'nearest'lot line------------------------= (. -------------------- 1 Reriodelin and/or repairing describe :_...----?.*----.,=_- --------------------- .... ---- ---------------- --------------------------------------------- ------------------------------------------------•----------------------------`---------------------------------------------- I hereby certify'that I have-prepared this application and thatahe.v;ork will be done in accordance with San'Joaquin County ordinances, State laws. and rules and regulations of the SanaJoaquin Local Health District. F I ti (Signed)------------------------------- ---- ---• ----------=-------'-------------- -----•------ -------------------------- I--------{Owner and/or Contractor) B --(Ti le)---------------- --------------------------------------------- ---- --------------------------------------- (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 `' w = ti APPLICATION ACCEPTED BY-------- ---- ---- ----------------------------------------- ---------- DATE..:-----. REVIEWED BY-----------------------------------` - - DATE BUILDING PERMIT ISSUED-------------------- ------ -------------------------- '=-'------- DATE-------=-- --- ------� ------------------- = Alterations and/or.recommendations:------------------ --- -- --E----------------------------------------------=`-------------------------------------- J ....---- 4 - ------------ - - ~ ---------- ----------- -------- ------•------------------------------•--------------------- ------- --- - -----------•-------------------- -----------------------•------------------ ----------- ----------------------- ---------------------------------------------- f FINAL INSPECTION' BY:__-- -- -__ tI �� = " = Date= -- --- t ' SAN,JOAQUIN LOCAL HEALTH DISTRICT i j 130.South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 4ZStockton, California Lodi, California Manteca, California Tracy, California i ES-9-2M Revised W-2100