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_hy r APPLICATION FOR SANITATION PERMIT Permit No. ._.k---4O_.4 (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. 549. EnJ 7`74 S7` JOB ADDRESS AND LOCATION __- __ '� .'_ _____ -� �' .-..-- __... �------------------- Owner`s Name------- ---------------------- ---- -- --- Phone------------------------------------ Address------------------- ----•- 7--- -----------------•- ----• - ------------------------------------ 14 Contractor's Name-------------- ------------------------------------------------------------- - ----- ----------------------------------------------- Phone----------------------------------- Installation will serve: Resid ce [�k Apartment House ❑Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,3-- Number of bedrooms ,..?_ Number of baths__ Lot size ----I_-.Y�-�' Water Supply: Public system ❑ Community system ❑ Private)k Depth to Water Table __--I--_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Play ❑ Adobe* Hardpan ❑ Previous Application Made: Yes ❑ Nox New Construction: Yes [-] No t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tanks Distance from nearest welL________________Distance from foundation--------------------Material-----------------------------____-___------ 4 No. of compartments---- ---- ---------------Size-----•--------------------------Liquid,depth-------------- - -------- Capacity----------------------- ___.Distance to nearest lot lin /_ __________- �[7 isposal Field: Distance from nearest wefl_.�.�0_Distance from foundation__ __ ____ ry, Number of lines----------I____________________ -Length of each line-------1_-�-_0._____ Width of trench----- '____.____. ___ ____ r '' )) /1_Total length Type of filter material__57i� _CDepth of filter materiaL__.___J__S__ _ g e Seepage Pit: Distance to nearest welL___________________Distance from foundation-------- to nearest lot line__ _-____-.__._. S1) ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------- Dept h--------__----------------------, Cesspool: Distance from nearest well-----------------Distance from foundation-----.------------- Lining material--------------------------............ ❑ Size: Diameter-------- -----------------------------Depth---------------------------- ----------------F-----Liqui.d Capacity---- ------------:-,galsL_ Privy: Distance fromnearestwell_________________________ _______________________Distance from nearest building - --- ------------------- ------ ❑ Distance to nearest lot line----------------- ---------------------------------------------------------------------------- Remodeling and/or repairing (describe) -------------------------------------------------•-••-------•--------... ------------------------ ------------•--•----------------------------------------------------------------------------------------------------------------------------------•------- -----------------------•-•---------------------------------------- ----------------------I----------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------•-----------------------•---------------------------------------- -------------------••------------------------------------------------•--------------------------------------------------••------•---------------------------------------------------•---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance witN-San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District.. (Signed.)----- " -------------------------------------- -------------- --------------------------------------------------------(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 APPLICATIO -------------- REVIEWED BY ACCEPTED BY ----------------------- - - ---III,& DATE--------- �- - ---------------------------------------------------- DATE--------- ---------- �.,* ----------- ---- -- - BUILDING PERMIT ISSUED-------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations-------------•---------------------------------------•----------------------------•-------------------•-----....•--._-...-•----------•------------------------- --------------•--__------------------------------------------------------- -------------------------------------- --------------------•------------------------•---•------------------•------------------------------------ ---------------- ---------------------------- ------------------------------------------------ -------------------------------------------------------•---------------------•------------------------------------------------ -------•--•-------------------------- --------------------------------------- ------- ------------------------•------------------------ ----------- ---------------- ----------------------------- -------- --•-.------------ ---•-------------------------------------------------- --•------ -- - --- -------------•------------------------------------------ --------------------------------------�------------------ 00; FINAL INSPECTION BY:..- ------ ----------------- Date----- ------f- / , r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 10-52 Revised W-2100