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APPLICATION FOR SANITATION PERMIT Permit No,3_- ---- `_-- ' (Complete in Duplicate) ( w a Date Issued �z7- 3t0-0-7 Application is hereby made to the San Joaquin Local Health District for a permit to consfacl and ins II + e work herein d crib d, This ap lication is made in ompliance with County Ordinance No. 549, � ICC JOB ADDRESS AND L. CATON _k_ -�' . ,,�. ,*` -------- ------------ = Owner's Name-----'-° A - --------------------------------------------------------------- Phone �... ----------------------- Phone- -.lee Address----------------------------- = Contractor's Name---------------------- � �-SIC=. ----- -•---------------------------- ------------------------------ Phone-----.f5i ?-0,- ----•--- Insfallation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑. Motel ❑ Other ❑ Number of living units: --6,- Number of bedrooms --3-- Number of baths --/-- Lot size ----_-_�--,? - --�Water Supply:Supply: Public system ❑ Community system -❑ Private X Depth to Water Table - ,- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam fA Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ® New Construction: Yes Z 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___ _ Distance from fc ation-____t-Y-_--____Mat ri I -.__ -------- [� No- of compartments-----:---- ------- -Sizee� ----------Liquid d wti,_--__-- 7- _ ---------Capacity-..--- - �---- P� Number of lines_------_-_- �------------ Length of each line- -' Distance to nearest to I �, _ -".-_ Dis osal field: Distance from nearest woll______ -__ 1 _ .----.Width of trench___---_ -___ o. ; istance rom oun at-o tr Type of filter material------I`_i � Depth of filter material-------Ig_------__-Total length--------------- ---------------- Seepage ------ Seepage Pit: Distance to nearest 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-------------------.---------------be th------------------------------------------- •- Liquid Capacity p � ----------------------- q p Y " __="" Dis#ante #rom'.neacest-building _________________________•___- �$ Privy: Distance from nearest well ____________-__ ❑ Distance to nearest lot line--------------------------------------------------------------------•-----------------------------------------------,------------------------- Remodelingand/or repairing fdescribe):--------------------------------------------------------------------------------------------------------------------------------------------------------- C-4� ----------------------------•--•------------•------------------------------•----------------------------------•--------------------------------------------------•--------- ------------------•-- ---------- ---=----------------------------------:--------------------------------------------------------•--•-------------------------------------------------------•--•----------- ----------------------------------- I hereby eerfify that I have prepared.this application and that the work will be done in accordance with San Joaquin County ordinances, State,jaws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- - ------ �----- -----------------------------------------------------(Owner and/or Contractor) 1 _ Imo✓ ----------------------------fTitle) �y: : a tPlot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ZZ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �' ---------------- DATE-------=- - ---------------------------- REVIEWED BY --� : -- ------ DATE -BUILDING PERMIT:ISSUED-------------------------------------------- ----------------------------------------------. DATE----------- - -- - ---------------------------- Alterations and]or recoTn�ehtla#ions:_-- _.- .- -- ------------------------------------------ ------- � �.. ----------------------------------------------------------------------------------------------------------------------------- - _______________________________ r_--._-__.___._---.----______-„----------____-----------______--------___--_---_----_--.-----__------____------___.-----____- ---------------------------------------'f.- - LRI1 _---------^---------------------------- - -- F/r, may. --------------------------------------- ___ _____________ FINAL INSPECTION BY: -="- ----------------------- -:{------------- Date------------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Stree+ Stock+on,'Califoraia f Lodi, California Manteca, California Tracy, California ES-9-2M 8.51 Revised W-2100