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� _' -{-- ---.•-.- ---�-PLICATION FOR SANITATION PERMIT Permit No.t[ 1 (Complete in Duplicate) " Date Issued ef1'_C0ons+rucf Application is hereby made to the San Joaquin Local Health District for a permand install the work herein described. This application is made in compliance with County rdinance No. 549, ��/ JOB ADDRESS AND LOCATION-- 7 /.- � �� ----�- -------------- Phone Owners me--••------- ------------ Contractor's Name----------------------------------PA_#-A._i�l-iEr "f--------- ------------------------------------------ Phone------9_-f-440 - ------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units--- --- s! - Number of bedroom _ Number of baths ------- Lot size __5 - --3 --f-- - ------------ -- Water Supply: Public system ❑ Community system ❑ Private V Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe X Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes k No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se er is available within 200 feet.) Ole istance from foundation_._ -_.Material__ Septic Tank: Distance from nearest well�(5______ �------- AS ----------- ------- - ------ , �/ - - ��r C�- _--�Liquid depth ------------Capacity_ No, of compartments---- --------------- -- -Size _ Disposal Field: Distance from nearest well�b__-_-Distance trom foundafiion____ +`-.Distance to nearest lot line___,✓ _ I Number of lines------/-___-__ ._-_-Length of each line__-��`-------------Width of trench-_va- ``-------------- , Type of filter material____ _-RA,-----Depth of filter material-----I If . length_______�'5----------------------� I R. 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_..-•_----------------------gal. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------_------------------------- ❑ Distance to nearest lot line ,41 Remodeling e and/or repairing (describe):----- __- C/- j----------- - -- ` 1 --------------------••---------•----------------••--------•------------------------: '- -- ----------------------- •---------------------------•------•--•--------•-------------------•----------•--•-------------------------- '-------------------------------------------•------------------------------------ --- -------------------------------- --•-----•-------•-------------------------------------------------------- ------------------------------------------------------------------------I------------------------------------- 1 hereby certify that I have prepared this a 'on and +hat th work will be done in accordance with San Joaquin County ordinances, tate laws, and r )es and regulatio s of th San oaqui oval Heal t District. ------ ------ ------------------------------------------------ (Signed) Contractor) By:-- ---•--- --- ------------------------------------------------------------------------------------------------(Title) . �7 - -12 , (Plot plan, wing size of lot, ca ion of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ - --------------------------------------------------- DATE_ ---------------------------------------------------- ------------------------------------- - REVIEWEDBY-------------------- ----- ------------------------------------------------...------------------- DATE---•- � --------------------------------------------- BUILDINGPERMIT ISSUED----------- ------------------------- -------- -------------------------------------- DATE----------- - Alterationsand/or recommendations:.------------------------------------------------------------------------------------------------------------ ----------------------------------•--••-•-------- ---------••--------------------•-------------------------•---••------------•---------------------------------------------------------•----------------------------•---------------------------------------------.------------- ---------------------------------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------- ---------------------------•- -------------------------------------------------------•-------------------------------•-------------•-----------••-----------•---:------------------------------------------------------------------------------------------ ------------------------------------ ------------------------------------ ------------------ ----------- -------------------------------------------------------------------------------- - FINAL INSPECTION BY:----------- fV;i Date----------7�14.77 ------------------------- 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 10-52 Revised W-2100