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m APPLICATION 'FOR-SANITATION PERMIT Permit No. C . .� [ omplete 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. 549. lei JOB ADDRESS A OC ION ____-.�-- -- --. Owner's Name------1 -- ----- ; -- ------------------------------- ----------------- Phone Address...... - Contractor's Name....... -...---• ----------------�..--------------------- - ------------ ------------ ---------- - ----------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court'[] Motpl ❑ Other ❑ Number of living units: _:L_. umber of bedrooms ___I Number of baths J--- Lot size . Q- -�� -- --------------------------------=----------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: SandEj Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe XHardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ .\ TYPE OF INSTALLATION AND SPECIFICATIONS: F .� (N/icank: septic tank or cesspool permittedc f ublic se er is available within 200 feet) - ,1 SepDistance from, nearest well-__ �`�istance fro [found f ion_�a ateri -- ' ------ ----------- _ No. of compartments------- -_ -------- fiFe_ ...yti_ _x�__Liquid d pth_ --:-- -, ---------Capaci#Y----- -p --- Dispos I Field: Distance from nearest II _ _.�D.istance from foundafion___I�--_ }ante to nearest lot line, 71 f ! �� -------- Number o-i lines___________ ------�______.... ..Len-Length of each line__________._ - Width,�f trench--_- --__ _ 1�' Type of filter materi - - t�'�� _ g �- --- ----------Depth of filter mater;aL.______�--e�-__-----Total -.length---------�-Q____:--------------._--- Seepage Pit: Distance to nearest well__--------------------Distance from foundation-------------------.Distance to nearest lot line--- ❑ Number of pits----------------------Lining material- - _' ---- ------------ --.-Size: Diameter--------------�- ----Depth--- ______ ___-____________.------ r�u Cesspool: Distance from nearest well,----------------Distance from foundation--------------------Lining.;material---------------------------_--------- ❑ Size: Diameter- ------------------------- -------Depth---------------------------- ------------ ---Liquid Capacity----- --------- -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest be Iding_-___-----_______________-- Distan°eexto�rrearest-lot�line--------- ------------......-------'.'..'='.•----------------------------------------- �-----�------- -- ----------------- ---------------- Remodeling and/or repairing (describe):------------------------------------------------------ •----------- i 1 i' ----------------------------------------- -------------------------------------)-.•------•---------------- ------ ----_---------------- I i --------------------- ------------------------------------------------------------------------------------------------------ ---------- , I hereby certify that I have prepared this application and fhat fhe ork will be done in accordantce with San Joaquin Counfy` ordinancesAS I ws, and rules and regulations of the San Joaquin Local Health District. ` a ti �. (Signed) ----.-- = --p--------- --- ----------------------------- ) (Owner and/or Contractor . Y - i i g ----------=-(�ife)-T--- -��------------------------------- --------------- (Plot plan, showi� size of lot, location of system in relation fo wells, buildin s, etc., can a placed on reverse side). _ f FOR DEPARTMENT USE ONLY J. APPLICATION ACCEPTED BY -----` k r* -..+�t. - c ---------------------- ----- - '---- '----'-=----DATE' -�---" REVIEWED BY----------- - . �1 Q �� DATE t..�- BUILDING PERMIT ISSUED---------------_ _ ------------------------------ -- ------------ - ------------------------- --------------------- ------------------------ DATE------- -----•--------------------•-------------....------- I Alterations and/or recommendations:---- _ == -------------------------------------------------=---------------------------------------------- -------------------------------------------------------------------------- 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 I0-52 Revised W-2100