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40 1 APPLICATION FOR SANITATION PERMIT Permit No. ....4�4�.. .____ (Complete in Duplicate) E.:. Date Issued Applica}ion is hereby made to theSanJoaquin Local Health District for a permit to construct'and install the work herein described. This application is made in compliance with County Ofdinance No. 549. JOB ADDRESS AND.LOC TION___.____ W - _-� -------------------------- -------------=---------- --vti, OwnersName-:-----__ -------- -_--- t / / v- Address •----------}----------------------•--------•--•---•--•------------------------- Contractor's Name-, •--- --- 1-•---- - _ �. Phone4:77U .0 Installation will serve: Residence'K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other .Number of living units: Number of beidrooms-_/____`Number of baths _,_ Lot'size - --__--_____ --------------------- Water Supply: `Public system []-'Community system ❑• Frivate-❑' De'pth'to{Water Table":_______ ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ElClay'Loam . E] Clay ❑- Adobe UT Hardpan ❑ Previous Application Made:; Yes ❑ No J1 New Construction: Yes ❑ No r- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) r Septic Tank: Distance from-nearest well-----------------Distance from foundation__.________________Material------------------------------- ------------ ❑ �Xrst No. of compartments--------------------- Size------------------------ ---Liquid depth- --------------------Capacity. -----•---------------- A Disposal Fi 6ld: Distance'from nearest well_________________Distance from foundation___.___--___-._.__Distance to nearest lot line._______.._______ ❑ }� Number;of limes___--°------------------ `----------Length of each line--------- �_}_'__�----.Width of trench----------------------------------- Type of filter material----------------� -Depth of filter material------------'-----_F---Total length---------------------------------•-------- Number.of its___�'�-��w� � Distance from foundation._;e� ..... _..Distance to nearest•lot•line_._____.___-__. ie - e ee a e Pit: Distance:#opearest.well� -) Lining mate ria l- � -��+ !--.Size:.Dianieter__ 03_ ._______Depth_..�t� -- ------------------------- Cesspool: Distance from'nearest well_____'-_____...__Distance from foundation._. ::"_':::_.Linin material_____________________________________. ' 9 ❑ 5ize: Diameter r Depth =---------- ------ Privy: ---- Liquid Capacity gals. Privy: Distance from nearest well_= __.__'----- -_____ _ -__- C ---- ---Distance-from nearest building-------------------------•------- -----. Distance to nearest;lot'line------ -"--=------------------------- - •-- _... . JRemodeling and/or repairing (describe):----------- .r.------- --•-- -• � - •---------------•-•------------••------------•-•--------------•- • ........ - ---------- -- - -------- ------------•---- ----------- --- _ _____________________________________________ _ ___________________________________________________________________________________________...______________________.__. ----------------------------------------- I ______________.________-__-______._._--I hereby certify that I,halp prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rubs and regulatrof the San Joaquin Local Health District, y (Signed).......--------------- --------- = " Owner an .ar Contractor) --=----- -- ------ • � c. ---------- - •Title -�4�( BY:; s_ ( } (Plot plan, showing size of !o#, location of system in relatidn to wells, buildings, etc., can be placeld'on reverse side). FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY-------------------------- - DATE------I 3�1 = --------------•----------------- REVIEWED BY - --�.----- ------------ --------------------- ---- -- DATE------------ ,] BUILDING S`% ISSUED___--------_-•------------ ------- ------------•-------- DATE------------------------------ Alterations ______________________ ____, Al+eratians and/or recommendations:------------ ----- - � 41 --------------------------------- FINAL INSPECTION BY:-":---- s ------- Date- --__- -. -- _"�- - a � 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 Revised'W-2100• - w r