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r ! APPLICATION FOR SANITATION PERMIT Permit No-7-010_--r----- .- ,1� A/ _r' j1� (Complete in Duplicate) j" `� Date Issued l -'____�____- Application is hereby made to the San Joaquin Local Health district for a permit to construct and install the work herein described. i ' This application is made in compliance with County Ordinance No. 549. JOS ADDRESS ND LOCATION...--- - �-'S `S� __ �j' Owner's Name ----------- ------- Phone ^/ u �� a ------------------------------------ ---------- Address---------------------- ------- -- ----- - --- - ---------------------------- Contractor's Name----- ---------- f- Phone Installation will serve: Residence //�Apm ._�r__ J----artment House ❑ Commercial ❑ Trailer Court El Motel ❑ ElOther Number of living units: ---/-__ Number of bedroos --- Number of baths __-_ Lot size -__ ,.7:�-X- O__ -_ p l----------------------------- Water Supply: Public system ❑ Community system ❑ Private [�epth to Water Table _S ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑, Clay Loam ❑ Clay ❑ Adobe ET-lHardpan ❑(� Previous Application Made: Yes ❑ No 2r�—New Construction: Yes e--'No ❑ (f�` TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welfl�$_---------Distance from foundation_40- _--___.Materia4-_ ______ No. of compartments------sa�---------------Size— ----_-_-Liquid depth_)--X�-___----_-_Capacity----6----------- � Disposal Field: Distance from nearest welL�4_-______Distance from founclat'on.:�0_----_-_-__Distance to nearest lot line-s�__---_-__ Number of lines----Z----------------------------Length of each line_-,l7"_�t�-I----.--.Width of trench-- Type Type of filter material--/L, -_---_----Depth of filter mai-erial__1--,--------------Totallength-JX0----------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- V ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------ ----------------.Depth-----------------------------_--- Cesspool: Distance from nearest well-----------------Distance from foundation----------.---------Lining material._______-_---_______-__-___-____.--. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest buiIding----------------------------------------- 0 Distance to nearest lot line--------------------------- -------------------------------------------------------------------------=---------------------------------------- Remodelingand/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 +he San Joaquin,Local Health District. ------------------------------- ---------------(Owner and/or Contractor) By:-------------------------------------------�--�-- ------------------------------------------------------------------------------(Title)------- ! (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 APPLICATION ACCEPTED BY------------- wl�- ----------- ----------- ------- DATE- --- -- ---- ------•-------------------- REVIEWED BY--------------------------------- ------------------------------------ DATE_-/ /---��-nS----:----------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations:—--------------- ------ ------------------.------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------•------------ ----------------------------------------------------------------------- ------------------------------------------------------------------•---------- --------------------- ---- ----------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------- - Y - ------ -- ------ - ----- i FINAL INSPECTION BY: --------------------------------------------- Date F j ---------------------- 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 E5-9-2M 8-51 Revised W-2100