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+�S APPLICATION FOR SANITATION PERMIT Permit No. :. ' (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. y Ordinance No. 549. —13 33 aG cn., �� JOB,A KESS AND LOCATION ll 4 i --- .. % op • . Owner's Name---------------------------------------------------Gi-Y01-•---------6 -Vb--------------- ------- - - Phone--- ----------------------------•--- -- ---- Addressi-------------------------------------------------•-•-----••-- v - ' Contractor's Name---------------- --------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ,, fNumber of living units: _-_____ umber of bedrooms __ _____ Number of baths _1 _� Lot srze _______d�J ____.- _ ¢----------------- Water Supply: Public system,❑ Community system Private "Depth to Water Table _4�ft. I Character of soil to a depth�of 3 feet: Sand Gravel ❑ SandY Loam ❑ ClaY Loam ❑ ClaY Adobe Hardpan ❑ Previous Application Made: Yes ❑ No� New Construction: Yes, No ❑ 1 I TYPE OF INSTALLATION AND SPECIFICATIONS: �l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------ from foundation_-.k__i� _(____.Material-------------- 41� _ No. of cam artments_____...__ Size_-1 _-SX.y. Li uid de th-____ _ _N:'t_.______Ca acit �� p -• q p. p Y Dispos Field: Distance.from nearest well____.r(-----Distance from founda(t,,1n-----�_�-------Distance to nearest lot line------i5�Nurr of lines__________ __ __� - __._.__ Length of each line_r+,2_ ?1k10-�7�/idth of trench____---- y r J rt ............ ---------------- cod r_ Type of filter material-------_.___----------Depth of filter material-------!STotal length__________C_. ----_____________ _- 's Seepage` Pit: Distal nearest well----------------------Distance,from foundation-----------_--------Distance to nearest lot line---___--__.___-_ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth--------------------------------- Cesspeol: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------.__-__- -� ❑ Size: Diameter--------------------------------------Depth------------------------------------------- --------Liquid Capacity----------------------------gals. Priv❑Y' Distance from nearest well______._________ a-----------Distance from nebuilding Distao nearest lot line- --------------------------------------- = '(1Z1 Y Remodeling and/or repairing (describe):------------------------------------- 4 -- -----------------------------------------------------.----------- .. _____ _________________________________-_-__________-____________-__-_____ 1: -?1 :. - I hereby certify that I have Prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat411 �, an rulesregulations of +he San Joaquin Local Health Distric+. Si ned - -------------------------( 9 )`--•--------- -----•---- ---------------•------------------------------- - ---- ---------------- ----------------------(Owner and/or Contractor) I j. 6 • -----------------------(Title)---'--------------- i (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 APPLICATION ACCEPTED BY-----------------------------------------&A-------------------------------------------- DATE------------- 1_....-,�� REVIEWEDBY--------------------------------------------- -----------------------------------------------:-------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------- ---------------- ------------------------------------------------------------- -----••-•-----------------------------------------•-------------- ---------------------------•-------------------•-•------------------------------------------------------------------------------=-------••------------------------•--------------.....---•----------------•------------------- ---------------------------------------------------------------------------------- ------------ ----------------•------------:------------------------------------------------------------------------------------------- FINAL INSPECTION BY-------------- ------•-- -------#--�-�� ----_---_- Date........3---------�.---� ------------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California , E5-9-2M 10-52 Revised W-2100