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`, ____-. .. APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 7s' Date lssuedl___•_�_'_....-_,t/ CApplica+ion 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 N 549. JOBADDRESS A D LOCATION--- Q7 ---------- -- ---------------------- ---------------------------- --------------------------------- Owner's Name------- - ----- --------- -- &------: ---1�--- --- Phone_ Address_...---------------------- '`-�---_ --------------..... =-----------•------------------------ -- -------•-------- Contractor's Name---U - Phonec.J_ w-fes Installation will serve: Residence k_11�partmenf House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/__ Number of bedrooms -_2— Number of baths /---_ Lot size ___-___________-__ Water Supply: Public system 6--[.ommunity system ❑ Private ❑ Depth to Water Table sipo. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ Noew Construction: Yes ❑ No [ -- �--- 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-____________.__________.___-_-._______________- No. of compartments-----r- ------------------Size--------------------------------Liquid depth--------------------------Capacity------ ---------------- isposal Field: Distance from nearest wel1�__Distance from foundation__/0�____._Distance to nearest lot line._,l .t [ � Number of lines---------- _ Length of each line___t/ _ _ - Width of trench.._ _________________ Type of filter mate rial__J.t.--_ t Depth,of,filter material------- 4e_ .....Total length------,_j____________________________ Seepage Pit: Distance to nearest we1r,7;---t-------Distance from foundation---fA0�_`_._..Distance to nearest lot ---Lining material_ ^-r�aF -?, Depth-----2-S_e- --------------- �•----- Number of pits_________._-_ . Size: Diameter____ __.. 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----------------------------------.-___._. ❑ Distance to nearest lot line---------------------------------- ----------------------------------------•--------...------------------------------------------------------- Remodelingand/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, S�tgte laws, an4rand regulations of the San Joaquin Local Health District. ------- - ---------------------- ----------- Contractor) [Signed}..--- - r_--- ---- - --- ----- -� �`'-- BY:---------- � a [Title} (Plot plan, sho irking size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------e6e-- - ----------------------------------------------------------------- DATE-------- / - -------------- REVIEWEDBY-------------------------------------------------- ------•---------------------- ----------------- -•---------------------- DATE-------------------------------•-•--•---------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------- ------------------------------------._...---------------•--•----------------...----•---------•-•------•--•-•--••------- ----------------------•- -------- ------------ --;: ----- ------------------------------------------------------------------------••--------------------------------------------------------------------- FINAL INSPECTION BY:._,__ _ ------------------------------ Date------------------------ ------ - i-------�x----- 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 E5---9-2M Revised W-2100