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APPLICATION FOR SANITATION PERMIT Permit No. -----�Y_.l.Q_..l (Complete in Duplicate) 3 Date Issued ....V/�� . 9e7.-!fro-t3 fl�"A 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. -3?O 2 ev � } JOB ADDRESS AND LOCATION-.- --- -------- .�..ar ¢Gv Owner's Name2 - - Phone .-a_ Address----_.-�? p/.v-- ----- --- ---------------- --ieContractor's Name------ Phones` - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___ Number of bedrooms-. Number of baths -.L_ Lot size .-7 �X.��_ Water Supply: Public system ❑ Community system El � Private rDepth to Water Table _xrff. 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 Pa, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: c'3 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---� --- ---Distance from foundation_.-&_1-------- e_..- 7 No, of compartments-------a---------------Size_s6_X_ya~...-.._._Liquid depth____. -------------Capacity__?s B _ SD Disposal field: Distance from nearest well---ofDisfance from foundation_...-a.---------.Distance to nearest lot line-------V ..-.-.._.. _ Number lines--------�------------------------Length of each line-----2s..- -------Width of trench-----!�y_---------•---_------ Type of filter material._Sc/?eTA-----Depth of filter material-----/f----------Total length----Z.S Seepage Pit: Distance to nearest well--/ - -__-_Distance from foundation_.-:5........,Distance to nearest lot line---`r ------ Humber of pits------- — _ /.-_---------Lining material-_. - - --_Size: Diameter-----3jlt----------Depth....r2. ------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--- ❑ Size: Diameter----------------- -------- --------- e fh----------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest well-----------------------------------_-------------Distance from nearest building-----_._..-----___.--__------------------ ❑ Distance to nearest lot line----------------------------- -------------- D� Remodelingand/or repairing (describe):--------- -----------------------------------------------------------------------------------------------------------------------••-------------------- ------•-------------------•---.....----------------•----------•------------------------------------------------------------------------•---------------------------•---------I--------------•-------------------------------- , - ---------- ---------------------------------------------------•------------------ --------------------------------------------•---------------- 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 regulation of the San Joaquin Local Health District. li�(Signed)------ `--- � ""�"' ------------------------------------------------- -----( ner and/or Contractor By: - �--�- - (Title -- -- ---- ---- ----- (Plot plan, showing size of lot, locati n of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- ---- --- ----------------------------------------------------------- DATE-------- ----------------------------------------- REVIEWEDBY---------------------------------------------------- --- ---------- ------------------------------•--------------------- DATE-------- ---- .' BUILDING PERMIT ISSUED---------------------------- ------ --------------------------------------------------------------- DATE------------------- ----------- 6 --- ---- -- --------- Alterations and/or recommendations-------------------- ------ C�` ---------------------- ------ -4-- ---------------------- -------------------•------•----_------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------•-----•-------•-•----------------------------------------------------------------------------------------------------------------------------------------------- -------------------------•---------------- ---------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------- ---•---------------------- FINAL INSPECTION BY:. .1 � a ------------------------ Date----- / SAN JOAQUIN LOCAL HEALTH.DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California €S-9-2M Revised W-2100 1