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APPLICATION FOR ( � - el, SANITATION PERMIT Permit No. A__________________ (Complete in Duplicate) to 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 Ordi�c` No. 549. JOB ADDRESS AND LOCATION___----97,—Ord - - -- i-t_ �_ ---------------------------------------------------------- ----------- Owner's Name. _ / -------j-------- ---- ----- �4Ga� <:: Phone- --------------•--•--••----- - ---------------------------------------7- --------------------_- J - - -- ------- ------- -------------- Contractor's NameCS --- Phone-_�?"'9 ------ Installation will serve: Residence �( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___ Number of bedrooms ___Number of baths __/--- Lot size _ ,�------------------------ Wafer Supply: Public system ❑ Community system ❑ Privatej' Depth to Wafer Table _�J___Vft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ Previous Application Made: Yes ❑ No J?_ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �'�"� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is T nk� Distance from nearest well-----------------Distance from foundation--------------------Material .�-+-'�-- <No. of compartments - Size -------- ---Liquid depth-------------- Capacity_ --------•----------- � � fv---- Y r s I Disposal Field: Distance from nearest well- Distance from foundation--/O to nearest lot lme___�__--• .. �. Number of lines-------- :______ _ Length of each 1ine �___ _-_ Width of trench-__�'�'___---•____._-__- �---er sf Type of filter material_) -----_-! �-}Depth of fitter material-----Z�---------Total length---_�t?-`-------------------------- � Seepage Pit: Distance to nearest w ' __ __ "Distance fro fou da#ion__.___ _ s � ,�Q________.Dis ante to nearest lot line____ Number of pits ---------------- materials Size: Diameter___-- - � ----- Depfh- aS-------------------- Cesspool: Distance from nearest well---------------__Distance from foundation------------------_Lining material_---____------___-___-______.__-❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------- --------------gagals. Privy: Distance from- nearest well- -------------------------------- (-- Distance from nearesr�buildiri T Distance to nearest lot line___ ------------------------------------------------ Remodeling and/or repairing [describe]:______.___--_______._ - --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prep red this application and that the work will be done in accordance with San Joaquin County ordinances; State laws,a rules and gulations ' the San J Local Health District. (Signed) *izeo�16f, - ----- ---Q��r� �� 1 -`------- 5 -- -�--------------- er Contractor) B :---- ---- --•.�- {4 -n- ------------------ (Title �- -3-�1-- �� --------- (Piot plan, shows location of system in a+ion to wells, buildings, a}c., can be placed on reverse side). r FOR DEPARTMENT USE ONLY • r APPLICATION ACCEPTED BY -- ------------- --------------------------------------- DATE----- -- i �...� REVIEWEIJ BY ----- - ---------------- ------------------------ DATE------ �''y - BUILDING PERMIT ISSUED--------------------------------------------------------------- ---------------- DATE------ A}eratians and/or recommends#ions_ ----•----------------------- __________________________ ------------------------••------------------------•--------- --------------------------•------------------------------------------- ------------------------ �i �� 7 FINAL INSPECTION BY: - Date / SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norfh "C" Sfree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9--•2M 8-51 Revised W-2100