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1 s APPLICATION FOR SANITATION PERMIT Permit No. - - �� (Complete in Duplicate) Date Issued'.L �=_-.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. JOB ADDRESS AND LOCATION -�y --------- Phone--- N p ' .�-- J( /rV ------ -t ---�`- '---------------------------------------- - -- �� Owner's Name-------•---•-----------•------------ Address--------•-•------------------------•••--••-•--- .-----------------------------...-.---------------------------------------------------------------------------------------------- Contractor's Name----------------------- ------ -C ------------------------------------- Phone ------- Installation will serve: Residence. Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _--4- Number of bedrooms z-. Number of baths __/_ Lot size ------527- ------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material -----.-_______.---.--------.-.-----_--__-------.Q No. of compartments----------------- -----Size-------•-----------------------Liquid depth--------------------------Capacity------------------- sal F' ld:. Distance from nearest wed o-------._Distance from foundation-_-4�__._.Distance to nearest lot line--_---;5�----- Number o-1 Numbero-i lines------!...... -- ---_.__--Length of eacli line--- I`?O--------------Width of trench ---------------- Type of filter material----�_x- - _--Depth of filter material------- --___Total length---------cQ----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation----------------.-_.Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------Dept h---------_--------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---------- ------.Lining material--.---------------------------------. ` ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building---------- .----------_----..____-----. ❑ Distance to nearest lotline --------------- -----..----------------------------------------------.-•---------------------------- Remo iV and/or repairing (describ -' '� - " 't� * --- - - . <-�rkAx.�.r- --------------- i ------------------------------------------------a--------•---------------------------•------------•---------------------------------------------------------- ------------------------------------------------------- - I hereby cer ' that I have prepared this Application and that +he work will be done in accordance with San Joaquin County ordinances, Stat la s, and r les an regulations of the San Joaquin Local Health District. A (Signed) ----------- -- ------ ----------- - ------------------ ---------------- ® nd nor Contractor By---------------------------------------------•--------------------------------- --- --- -- - ------------ ---- -----(Title)---- �� . _1�'�-��®�~ --.... (Plot plan, showing size of lot, location of system in rela i n to wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------------------------------- ------------- - DATE // -fJ-----F -------------- REVIEWEDBY--------------------------------------------- ----------------------------------- --------------------------------------------- DATE-------------------------------- ------- ------ •---------- BUILDINGPERMIT ISSUED------------------------------------------------------------------•-=--------------------------------- DATE--------------------- --------------------------------------- Alterationsand/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 10-52 Revised W-2100