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APPLICATION FOR SANITATION PERMIT Permit No. ___t1__7___- (Complete in Duplicate] Date Issued 4_7-_11 `T'/ 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. r JOB ADDRESS AND LOCATION___- -"ar " --- ---------------- --------------------------- -- ----------------------------- Owner's Name----tR :_- _________ ______ (1� •- ---,- ------ -r -�,` _ ------------------------ -------------- Phone--- Address---- . Contractor's Name" .!"':„-"0W-------- rte. ------------------------ Phone--- Installation will serve: Residence VOR" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ' ❑ Other ❑ 1 Number of living units: _4-_. Number of bedrooms __/___ Number of baths __�___ Lot size ______ I Water Supply: Public system V Community system E] Private ElDepth to Water Table ________ ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No �f New Construction: Yes ❑ No 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,9?70?.e_Distance from foundation__---- r _.__.Material__________________ ___ Rr r ----------------- No. of compartments---------�-------------Siz �� X��"--------Liquid depth----�,�_.�-_-- ----Capacity--000..- � Disposal Field: Distance from nearest wei Distance to nearest lot line___-_____ .___Distance from foundation_____ Number of lines----------*#--- """-- Length of each line-------/_4----------------Width of trench------�Y_'"°- �7 Type of filter material__��t_____./' , _-Depth of filter material----A- «�--:"_----Total length-------AS'-"f_-,"""_""""-•---------- ` Seepae Pit: Distance to nearest well ,.P-n.t---"-"Distance from fond _`� ation_____A ---.Distance to nearest lot line__1�_ Number of pits._-----/_______-__Lining maferial_�F'__ _-Size: Diameter_-_--_ Cesspool: Distance from nearest weft-----------------Distance from foundation_-----_________-__-Lining material-___________________ ❑ F�Size: Diameter--------------------------------------Depth------------- ------ ---- -------Liquid Capacity ----•----- - --------- Privy: Distance from nearest well______________-_------------- ---------------------------------------------------Distance from nearest building------- ❑ Distance to nearest lot line_-----_-__-___-___ Remodelin and/or repairingdescribe :__ __ ---------------------------------- ------------ ----------------------------------------------------------- -------------------------------•----------------.-----------_-------------------.-----------------------•------------------------------------•--------•----------------------.----------------------------------- I hereby certify fhat 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)_AA"__ - ------------------- - ------------- ---------- ----------- ----------- ---------------_------- ----------trrd/or Contractor) 11 BY: _� __ _ ...._ ---------- ------------------- --- ---- --------------------------------------(Title)- -----------'-'-"�=---------" ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-__ _-_____--_-_ _ DATE___-"' 15 -------------------------------------------- REVIEWED BY ---------------------- - ----- --- BUILDING PERMIT ISSUED- DATE ---------- ---- •-------------------- ------------------------------------------------------------------- ---------- DATE---------- - * Alterations and/or recommendations: fy��---------- ------------- ---------------------------------- ------------------------- ------------------------------------------- -- -------------------- ------------------------- - ------------------------ -------------------------------------- FINAL INSPECTION $Y:__-___•"""---- - _ "' I ------------------------- ) -- Date ----C--�---------- , h ! SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 'ES-4-2M 9-51 Revised W-2100