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l _ q APPLICATION FOR SANITATION PERMIT Permit No. -3---..9�..._. (Complete in Duplicate) Date Issued II� 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 Ordinance No. 549. I JOB ADDRESS AND LOCATION ' --------- ------------ -- -----------4----- ---- j Owner's Name -"�- 1�------ -•---------------- 1 - ------- ---------------- hone- Address------------- one. Address---------------- -----------------'�---------- ------ -------- ----------------------.._..-------------------- i Contractor's Name ° / ------------------------------------------_ Phone Installation will serve: Residelncek Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units! -------- Number of bedrooms Number of baths .....-._ Lot size ...................._._.. _...__-___ Water Supply: Public system' Community system El Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ii Previous Application Made: Yes No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitfed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation_---- U._- Material---------------____--- ____-_... No. of Xcompartments___-__Py-----------Size___.`4_K-.�L.X. Liquid depth_____._. .��.__�__Capacity----------------------- Dis o I Field: Distance from nearesf well#.`_ ----.-Distance from foundation---- _Q--------.Distance to nearest lot line...._--------I- Number of lines----------_.Y_...nn , Length of each line_.._..___.: --------Width of trench__-_-.----7*r Type of filter material.. ._!'�K.-.Depth of filter material__.-_._..._...----__..Total length...................../l_Cp-...._.---- Seepage Pit: Distance to nearest well----------------------Distance from foundation_._!---------------,Distance to nearest lot line................. ❑ Number of pits----------------------Lining material----------------------.Size: Diameter----------.------------Depth---------------------------------� Cesspool: Distancol�from nearest well-----------------Distance from foundation------------------- material--------------------------------------- n Size: Diameter-- ------------ ------------------Depth------ ------------- ------- ---------------------Liquid Capacity °- ------------------------gals. Privy: Disfance from nearest wwell._A--------=-------- __.- -.--.-Distance from nearest building----:--------------------------- ------_- ❑ Distance,'to nearest lot lire---------------------------------------- ~ Remodelingand/or repairing (describe):---------------------------------------{---------- ---•••------------------------------------------------------------------------------------------------ II ----------- '----------•---------------------------- -----------•----------------------------•------------------------------------ ------ ----------•------------------------------------•---------- Il I ---- ----------------------------------------------- ------------ ------ ----- 1' --------------------------------------------------------- ----------------•--------•--------.......---------------------------- I hereby certify that I have prepared this application and fhat the wo w'll be done in accordance with San Joaquin County ordinances, State laws, d " les and regulatio of the San Joaquin o alth District. { (Signed}. = - -- ----------- -------------------------------------(Owner and/or Contractor) II (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------ DATE ` II f - ------------ REVIEWED BY ------------------------------------------ DATE BUILDINGPERMIT ISSUED_I'-----------------------------------------4--------------------------------------------------- ---- DATE------------------------------------------------------------ Alterationsand/or recommendations:----- ----------------- -------- - -----------•----------------------------- -------- ------------------------------------------------------------------- P ------------•-----:•----------------------------------- ;i -------------------------------------------------=-- ------------------------------------------------------------------------- ------------------------------------------------ --------- --------------------------------------------•-- --------------------------•------------- h II Illi. u ........ Date , /�_"��'/ FINAL INSPECTION BY::.._._...,...` ii II SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street II 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California ii Lodi, California Manteca, California Tracy, California n ' ES-9-2M I0-52 Revised W-2100