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I� APPLICATION FOR SANITATION PERMIT Permit No. ------C/a - _ (Complete i� nDupliCate) .• Date Issued _�__._z_ .......... 4 Applica-�ion is hereby made to the San Joaquin Local Health District for ape�to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. i�• JOB ADDRESS AND LOCATI N.. -C- -----------�_________ --L .. ---•-- `t' ..............••---•--------•-••--------•-•-•---------------- --------------------- Owner's Name----- -�...... ` • . .......... -- ----- Phone----------------------------------- Address--_------_---------�?.Z - - Address__.--------•-------- .Z- ---------W-------- ------------------------ ---------------------------------------------------------------------------------------------------------- Contractor's Name_------------ '- ---- ------------------------------------ ------- ---------------- Phone..-.---- ------------------- .... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ 5 Number-of living units: _. ___ Number of bedrooms __Number of baths ----/_ Lot size _.________ +Wafer Supply: Public•system I Community system [I Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand.El Gravel Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construc ion: Yes (y No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer pailable within 200 fee+.) SepticTank: Distance from 'nearest well�'11e 7 'f om foundat�----—/0-----__.Material---------------.--_-___--_-_--_---.._.---._ s i No. of compartments-----------11---------Size_..-..._ jX,!;Liquidrdepth------------ -------Capacity-----g�?_--0 Disposal Field: Distance from nearest wells � i ar c2 from foundation-----!_S-.___- .Distance to nearest Iof li�� Number of lines-------- ________________._._ LA gth of each line__ _'_` _�_ Idth of trench.____3dV_- -----._____________ ? Type of filter material-_S-1 e th of filter material-_ `_ _ '�� Total length ko-_�-------------------- YP � p f�---------•-- g 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---___._--._ fi.___ Lining_ ,m- aterial_-__-.-------_---_--_-_---_--!__ --a--_- . ,_ _ IeSize: Diameter--------------------------------------De Depth -------' -Li9u-d Capacity- -;g - Privy:" Distance from nearest well----------------------------------------------- from nearest building--------------------------------- ________ ❑ Distance to nearest lot line---------------------------- -------------------------------------------------------------------------------- ------------------------------- Remodeling and/or repairing (describe):__--- -__--- ---- ----------------------------------------------------------- .____. _ ._ -_-___ _ -----------------------------------------------------._.._.-----_------_--.__. -_-- ... • ----- ---------------------------- --------- - - - ------------------- ----- ----- - --- I hereby certify that-1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatigns of the San Joaquin Local Health District. (Signed)__ ---------------------[Owner and/or Contractor) - - ---------------- - , By:-_•----_----------•------------- ---------------------- --------------------------{Ti+le}------ --------------------------------------- [Plo+ plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -.. - `d APPLICATION ACCEPTED BY------ ------ ' +'__�1� '---------------- DATE------------- --- l r ,t REVIEWED BY DATE------_,_- -3--------------------------------------- BUILDING PERMIT ISSUED._.._-•--..-_------ ------------ ---------------------- --------------------------- -----I— DATE-----�-------- ---------------------- ' ------•----------- Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------------------------------------------------------- - -------------------------------------------------------- ----•------------------------------- --------- --.._...--------• --- ------------------•----- -•------------------------------------------------------------------ 4 FINAL INSPECTION BYi....__..- ......... `� - �" Date - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M Revised W-2100