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` APPLICATION FOR SANITATION PERMITPerrniNo:x y (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. 1 . I` JOB ADDRESS AND LOCATION____ -- ------------------------------- h r Owner's Name------ �- y - ---------- - -1 11.. -------------------------------- Address ------------- - _ _ _ Phone L� ________________ ��___ Y� Contractors Name_---___; ----- Phone---44D---Installation will serve: Residence W-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: __- Number of bedroomsumber of baths __�_-,Lot size _ _ � 0-P t, :-•N _ _ Water Supply: Public system ❑1 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 ardpan ElPrevious Applicatio °n Made: Yes [] No 00. ew Construction. Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' ' i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! �" € : Septic Tank: 'stance from nearest well_. U-_!_---Distance from foundation---------------____.Material-____ o. of compartments---- -----.=-----'-----Size--------------------------------Liquid.depth.------------`-------- t ----------------- * 3 -- CapacitY---------------------------- DisposalId: Distance from nearest well__ _ _ _.Distance from foundation-----------_--------Distance to nearest lot line___ -_____ r Number of lines-.-__ --- __ • _ Length of each line_— -#-~,, j"�--_---Width of trench- �_�____---_ Type of filter mat ial'- Depth of filter material-__/ �� Total length---�- - _. eepage Pit: Distance to near st well ----- ------------Distance from foundation------------------__Distance to nearest lot line_-_____-_________ ❑ Number of pits----------------- --Lining material-----------------------Size. Diameter___--------------------.Depth____---___-------------__--- Cesspool: Distance from nearest 'well________________ Distance from foundation-----_____.___---_.Lining material_______-__________-__- ❑ ------ Size: Diameter--------------------------------------Depth----------------------- ----------- -----------LiquidlCapacity�-_- - gals. Privy:rt Distance from' nearest well-------------------------- s, . ,_..__,_____Distance from nearest building g ----------------- .. ❑ Distance to nearest lot fine--------_-------------------------- f-' -------------------------------------------- r� ` Remodeling and/or repairing (describe):_________________________ t. ---------------- �. t ----- -----•-------------------- '-- r - -------- --• ----------------- - ----• ---- ------•---- ! -see . --------------- ---------- ----------- J ---------------------------•-------------------•---------R----•-------•---I•--• - - -- -- yQ -- •-------- -----------------------------------•------------------------------------------------------------------- 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)_ 1___E7 '' --------------------(Owner and/or Contractor) ----------------------- BY:----- `� + - ------- ----- - (Title) (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. �r APPLICATION ACCEPTED BY-_- - DATE_ -------- ------ ------------------ REVIEWED BY - --- - ---------T ---- -------------------------------------------------4------------------------ DATE----=- BUILDING PERMIT ISSUED ---------------""-��------------------- - ----------------------- DATE------------Rf%' ---------------------------------------- Alterations and/or recommendations ------------------------------------------------------- - ; ---------------------------------------- - -------------------------------------------• ---------------------- ------------------------------------------ --------- ---- --- FINAL INSPECTION BY:----- ------- ------------- .�° - -------------------- Date------------ -----------------.- -•---- t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 8.14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M a-51 Revised W-2100