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4t APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica-lion 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, C71-2-40-07 `, 2�` JOB ADDRESS AND LOCATION___.__ . _.-_�� d,_�•. � � .�-�,1__-��._ �` [ Owner's Name----• -- . --- f = hone-.- ---- t a Address_ �- ------- -------------- Contractors Name---------_-------•- r A '[ 9 `Fs ` Installation will serve: Residence �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 ❑ Private 9-- epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam [❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes [] No [ `I]New Construction: Yes &'110 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w-ell_.__ P----Distance f om fgyndation-_./�--------Material Z �---�-� No. of compartments---- ----------- P_--Liquid de th_--- _ .---___.-Capacity---- Disposal _Ca acit Disposal ¢2` ` ------- Field: Distance from nearest well Distance from foundation_-_e--------..Distance to nearest lot -___-- ®� Number of lines--_->-,f-----------------------Length of each line_--__�'• -__-_-..-.Width of trench-...__:��-tf - -------------- Type of filter material._.f--6--------------Depth of filter material---- --f--. `� r ` ^ 2. ------Total length ------------------------- .1 Pit: Distance to nearest well-__%`ems'.__ Distance from foun 0 ation_._. �_'_--.Distance to nearest lot line__.��_- Number of pits...../-------------Lining material.41G.,0gl y4ize: Diameter_-.44 '�� Cesspool: Distance from,n.earesf%well-----------------Distance from foundation------------------- Lining material-------------------------------------- F-1 ----_---__------_---_-❑ Size:Diameter----------- ,4;----; ,• Depth--------------------- ----------- -----------------Liquid Capacity---------------------------- # Privy: Distance from nearest well-N.,---------------------------------_----.-Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line---- ---------------------•-------- --- - ---------------- - ------•------------ Remodeling and/or repairing (describe):- _ _ a r .-: -•-------------------------••----------------------------------- -••--- ---------•-••------------------•----•------------- -------------•--------------------------------------- •---•--•--------••------------•------•------------=-------------------------------•---•------------------------------------•---------------------------------•--------•---------•-----------•----•--------------------------- -------------------------------------------27• ------------------------------------------------------ --------------- =-------------•----------------------------------------------••----------•------------------ I hereby certify that I have prepared this application and tha•}the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o.he San Joaquin Local Health District. (Signed)----------------- i -------� - 3 — ' es'. By------------------------� '.Es--- �� -�� -------------- -----•----•--------- ------------------------(Title). -s r Con---- tor) (Plot plan, showing sixes lot, location of system in relation to wells, buildings, etc., can be placed on revers! side). + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 'BY- DATE------------------- -------------------- REVIEWEDBY4 ------------------------------------------------------------------------------- DATE--- - -------------------------- --- BUILDING PERMIT ISSUED------.----------------------------------------------------------------------------------------- ------ DATE------ --- -------------------------------and/or recomm dations- ------ ---------- -------------------------------- --------------------------------------------------------- ;= -----------••--- :. -------•---------••--•---------- --- - --- --- -" --- ----------- ;k- ------------------------------------ -------- ------------ ----------- ------------------ ff FINAL INSPECTION B =----------- - -------- Date. '------r- --- -..- __. R 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 145446 ATw000 12-5.4