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(Complete in Duplicate) N PERMIT Permit No,d?I"7 APPLICATION FOR SANITATION y� Date Issued L-"0---_s 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 Ordinan5% No. 549. JOB ADDRESS AND LOCATION--- __- " _---/ , :_" ------------- " ' -- ----------- --------------- Owner's Name--- ---------- ------ ------- Phone--, - /004---------------•- Address ---------. _01K Contractor's Name----DA-=------- � Phone- ---•------ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other Ej Number of livingunits: --- "__- Number of bedrooms _ 2—' " Number of baths ""_ _- Lot size __","'_!� °"- _, "�_ Water Supply: Public system )� Community system '❑ Private ❑ Depth to Water Table 7— ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay-E-1 AdobeLy Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ 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 foundation-______---p-_--_.Material No. of compartments--------------------------Size--------------------------------Li uid de th--------------------.- -Capacity ,. Disposal Field: Distance from nearest well__--------------Distance from foundation---------------------Distance to nearest lot line---------__---_"" Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------"----------_"- - N I . Type of filter material-------------------------Depth of filter material---.-----------------_Total length---------------------------------------------- Distance -----------------__- ~ Seepage Pit: Distance to nearest well_- _Distance from fo ndation___!, "___.Distance to nearest lot +`��f Number of pits--------"t------_--Lining material--- __,_Size: Diameter--__-. .3-�'" -----.Depth ----�-�-�'-°-----•--------- 7 �►" Cesspool: Distance from nearest well -Distance from foundation-------------'_--,__.Lining material______.."__._______"" ❑ Size: Diameter--------------------------------------Depth------------•=------------------------------------------ / - --- --Liquid CapacitY---------------------=------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------------------------------------------------""_" Remodeling and/or repairing (describe)---------------------------------------------------------------- ------------------------------------------------ ----------------•--------------------------------- ------------------------ -------------------------------------------------------------------------------------------------------------------------- --------•------------------------------------------------- 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 regulations of the San Joaquin Local Health District. t � (Signed)----D_tr - /or Contractor) BY� (Title)--�� = le W-- - - - ----^ ----------------------- (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 ------------------------------------------------- ----------------------------•----------- DATE- REVIEWEDBY -- ------ ----- ----------------- -------------------------------------- DATE-- - --------------------•-------- BUILDING PERMIT ISSUED ----- -- ------ DATE----------- - �--------------------------------------- Alteration s and/or recommendations:------------------------------ ---------------------------------------------------------------------- -----------------•-----------------------------"""-- ,� -------------------------------------------------------------------------------------------------------------------------------------------------------•------- -------- ---------------- FINAL INSPECTION BY:--------- , 4/ ----------- ---�-------- Date----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street- 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California { ES-9-2M: 8-51 Revised W-2100