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APPLICATION FOR SANITATION PERMIT Permit No. _ �_ •. _ (Complete in Duplicate) Date lssued/0_-4.3_-3—/ 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. JOs . 4EC- ,0a e�oo s7-, B ADDRESS AND LOCATION. �- -------- ----------f .4-- Owner's Name----------------------- = ------ -- ---------------------------------------------------------- Phone * (�� --- Phone Installation will serve: Residence OR- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ Number of baths -!� r��Number of bedrooms -- ___-- Lot size ---/10 ----------u---------------------------- Water Supply: Public system [:] Community system ElPrivate epth to Water Table -------- ft. 0/OLAW3 , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R;-�Iarclpan ❑I Previous Application Made: Yes ❑ No qew Construction: Yes N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) [, Septic Tank: Distance from nearest well-________________Distance from foundation-------------------Material__________________________________________-___.I No, of compartments______________________ ___Liquid depth--------------------------Capacityi Size______________________'------ . `� Dst�rto nearest lot line-,-.1--a b--x Disposal Field: Distance from nearest well- off__�_ stance from foundation_-_/.^__ p Number of lines_-----------� ---=- '__Length of each line____�-.D__` ------ ----Width of trench_________ ------ P- ___ Type of filter material------)�_PI_-_ 4Depth of filter material-----__-__' _--------Total length_____________ IT-0 Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--_-_--__________ � ❑ 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 building------------------------------------------ 171 Distance to nearest iot Iine---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/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 the San Joaquin Local Health District. OF (Signed)-- --------------- -------- -- ,,rX--•---------------------------------------------------------------------------------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)------------------------ - (Plot 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-------------------- - ewt--------------------------------------------------------- DATE------------- JAS REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------•---------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------------ --- ------------------------------------------------------------------------------••--------••- ------------------------------------- -------------------------------------------------------• -•----------•---------------------------------------------------------------------------------------------------------------------------•---------------------------- -------------------•--------------------- ----•--------•------------------------------------ -------------------------------------------------------------------------------------------------------------------------------- ---------- ----------•------- --------------- 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