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of ' APPLICATION FOR SANITATION PERMIT Permit No.d6,m-o_si__D .... (Complete in Duplicate) Date issued � ________� 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. 599. f ---- -----. JOB ADDRESS AND LOCATION- d1_G7• -l -�f,'� Owner's Name_____________________ / « .+ 5_ 1"' �_ ---------------- ---- Phone--------- + ------ Address -•••------------------------------------------ " �j - ------- ------- ------------------------------------------ ---------- 71*1 Name--------------•-•--•--------�,�__ _`-- Phone "f ,Pa installation will serve: Residence)f Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑. # Number of living units: _j____ Number of bedrooms ---_ Number of baths J___ Lot size ___ - _ __ _ __ _' _______________ Water Supply: Public system Vt Community system ❑ Private ❑ Depth to Water Table*,;Pft. Character' of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑� NoA New Construction: Yeso 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 w I__ _�`-__Distance from foufn� tion__/�- -__--M,aattserial_,_._____ __ ______ __________ No. of compartments____ ________________Size4___4 __�iquid depth____%VWZ--- 4 U Disposal Field: Distance from nearest well-_�t_d2_____.Distanceom foion_____�_. !__Distance to nearest lot line____.__f .'� __Length of each line______"�7ZO---_________.Width of trench__�_"rt�__!�_________________ Number of lines--------/--------�- __-- g Type of filter material---- �� _Depth of filter material-------/{!` ____Total length-_ -!!__"_______________________ O See pa a Pit: Distance to nearest well-/40-A_°......Distanc� f- fou}�dation_iv_?–X____ ate_3_.__.Distance to nearest lot Number of pits____/--------------- 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 building----------._.------__--.-__-__________- ❑ Distance to nearest lot line---------------------------.-------------------------------------------------------------------------------------------------------------- - Remodelingand/or repairing (describe):------------------------------------------------ --------------------------------------------------------------------------•------------------------ Q r. ----------------------------------•---- ------------ f ---------------------------------------------I------------------------------••-----------------------------•---------------------------------------•---------------•--------------•------------------------------------------ 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 ulfs and regulation _of:he San Joaquin Local Health District. li (Signed) .1_________________ Contractor) - *- ---_ ----- _ k - By:---- '� '- -- -------- ---------------------------------------------------------------------- (Title} CFS+- --------------------- (Plot plan, sh ing size of lot, locatio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPART NT E ONL APPLICATION ACCEPTED BY________i____ _-__ ___�_. � - DATE_________ _ REVIEWEDBY------------------------------------- ----------- ------------- - ------------------------------------------------------ DATE------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------------------------------------------------------- Alterations and/or recommendations---------------------- -----------------------------------------------------=---------- ------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- -------------------------------------------------7------------i----------------- ------------- ------------------------------------------------ -------------------- -------------------- ---------------------------------------------------------------------------------------- ----- ---------------------------------------------------------------------------- - ---------------- ----------- ----------------------------------------------------------------------------------------------- FINAL INSPECTION BY: Date --------------- 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 ES-9-2M 8-51 Revised W-2100