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yF APPLICATION FOR SANITATION PERMIT Permit No. L.7_ (Complete in Duplicate) Date Issued lR/ 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 $49. JOB ADDRESS AND LOATION ...____ ------------ ------------ - Owner's Name-_ -- -____- Phone__ _ __ ------ Address.- - ------------ - _ Confractor's Name----- = �� ------ Phone_ --... � . Installation will serve: Residence Apartmenir ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units:_____ Number of bedrooms - __ Number of baths / Lot size ---- Water Supply: Public system E] Community system 0 Private Depth to Water Table t. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [-] Clay E] Adobe Hardpan C1 Previous Application Made: Yes ❑ No PlfNew Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECT 1CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic.�Tank: Distance from nearest well_________________Distance from foundation--------------------.Material------------------------------------------------- 4 _____-__-______-_ ----_______-_________________- �`I�/f J� No. of compartments--------------------- ----Size Liquiel depth- Capacity /49-____.__Distance to nearest lot line___ ____ Disposal Fie d: Distance from nearest weILQ._-_____.Distance from foundation.__ _ Number of lines______________________ _______Length of each line_____'_D_------ __._.Width of trench____�_-j--_______________- Type of filter material __ -------Depth of filter material----/57_-__ Total length------- --------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------------ L] Number of pits-------f------------.-Lining material-----------------------Size: Diameter-----------------------Depth----------------------------------- Cesspool: ------------------ - Cesspool: Distance from nearest well------_----------Distance from foundation--------------------Lining material_________:s____:_--..-___________--_. ❑ Size:,Diameter--------------------------------------Depth----------------------------- Liquid Capacity gals. Privy: Distance from nearest well________________________________________________Distance from nearest building______-___________--_____•__-._--_____-_. I ❑ Distance to nearest lot line____ __ --------------------------------------- ------------- ----------------------------------------------------- Remodeling a'nd/or repairing (describe):_ ` ----------•----------------------------� ------------------- ------------------ ------------------- -- ----- -- -------- •-------------- -------------------------------------------------------------------------- ---- ------------------------------------------------- --- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, d r-wies and re tions of the San Joaquin Local Health District. (Signed)-- - ---- ------ ----- -------------------------------- ----(Owner ad �< ontractor) By:------- ------------- ----- - ----- -- --•------------------------------------------------------------------------(Title --------- ---- (Plot plan, showing si o [of, locatio of system in relation to wells, buildings, etc., can be ed on reverse e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ---'---------`--------------- --------------------------------------- DATE _ - REVIEWEDBY--------------------------------------------- ---------------------------------------------------------- ------------------ DATE------------------------------------------------------------ =K- ING lII "ft" -------Y- :----------Y -"r-- -- ---------Dand/orPERMIT ISSUED r - DATE Alterations recommendations: c ! ------------------------------------------------------ - ------------------Z-------------------------------------------------------------------- -- FINAL INSPECTION BY---------------- k -/o__'----------------- Date----------- �}~ 'Z ------------------------------------- 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 B-51 Revised W-2100 lei