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APPLICAT`I�.,,. R SANITATION PERMIT Peri 4'4� e__�_ _ _ (Complete in Duplicate) -.Da'te Issued Application is hereby made to the San Joaquin Locai Health District for a permit to construct and install the work herein described. This application is made in compliance with County O finance No. 54 . JOB ADDRESS A LOCA ON -------------- Owner's Name --------------------------------------- Z �T--a ---- Phone-- -1 4j_1t;` Address---------7-1 -;Fv —r4 . - Contractor's Name.-,------ ------- -------------------- ------------ Phone Installation will serve: Residence Apartment House ❑2Cgmmercial ❑ Trailer Court ❑ Mote �❑ Otherr ❑ Number of living units: _-'____ Number of bedrooms _t�} gg _- Number aths __--1.. Lot size ______�_-_-_-__�-�� _ -- -------------------------- Wafer Supply: Public system ❑ Community system ❑ Private Depth t Water Table-------- ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ' Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: Yes [ �o ElNew Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic nk: Distance from nearest well.. .gDistan ek om uAd (/ - ------------Materi I ------- -- - �} �,F No. of compartments Size dept depfi `1r- CaPacitY Disposa field: Distance from nearest we __&stance from foundatio _--- -- - -__-- istance to nearest lot lin ------ ----- _0 of lines_________:._ __ Length of each line___ _ _-_-4dth of trench______ __ _ f_j_------------ Type __________ T e of filter mate e t Yp .- Q p h of filter material------- Seepage length___-__ _ -Y--•------•------ Seepage Pit: Distance to nearest well---------------______Distance from foundation--------------------Distance to riearest lot line_.-__--_--__----. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth---------------------------__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_----------____-__-------_---.----.-. ❑ Size: Diameter--------------- Depth---------------------------- Liquid Capacity = al Privy: Distance from nearest well--------------------------------------------------Distance from- nearest buildin ❑ Distance to nearest lot line-, Z_ 9-------------------------•-------------- • ---__--._-_- - ------ --------------------------------- 5 Remodeling and/or repairing {describe):-- ---- ---- -_____ --------•-------••---------------------•--------------------------••-- ------------------------------------------------- = ------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County, ° ordinances, tate laws, and es and regul tions of +he San Joaquin Local Health District. (Signed)__ g — ---------------------------------------------------------------------------------------{Owner and/or Contractor) 1 By:------------------------------------------------------------------------------------------------------------------------------------Tale (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 I APPLICATIONACCEPTED BY -------------=-------- ------------------------------------------------------- DATE- ----------------------------------------------------- REVIEWED BY ----------------------------------- ----------------------------- DATE BUILDING PERMIT ISSUED--------------------------------------------------------------- ---------- --- ---- DATE----- Alterations and/or recommendations------- ----------- ---------- = ------------------------- ------------------------- --------- ---------------------- �v �'_C (`'^' Lg '---------------------- ---------------------------------------------_-- -�� �'► - `, = � � / --------------- ------------------------- FINAL INSPECTION BY--------------------------Il `- y �/ Date ---------- + s� 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 • 1 ES-9----2M 8-51 Revised W-2100