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r+ APPLICATION FOR SANITATION PERMIT Permit No. .(�__7..?— (Complete in Duplicate) l S Date�lssued ._73 _ r 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 witunt Ordinance No.t549. A' `, 4 JOB ADDRESS AND LOCATION------ ------------ ------/ - ------------------------------------ Owner's Name ------- Ph�e �/ ,. i n' f J�~~� Address-------... __________ 4 Contractor's Name..--=-----•--- ,r�� .-- - �I -- \-- Phone----�------------- -------------- k Installation will serve: Residence' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Pther ❑ Number of living units: :_(___. Number of bedrooms 4___ Number of baths J--- Lot size _ Q - ------------------- Water Supply: Public, system Community system ❑ Private ❑ Depth to Water Table i?! • ft. k 1 r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam'❑ Clay ❑ Adobe 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.) ~ Septic Tank: Distance from nearest wel#_,ftzD,�_-Distance from foundation- ---------- ------ IiAo � t -�• -------,Material----- ------ - ----- --- No, of compartments------a�- --------Size_-a},r ,r --.Liquid3------Capacity-__C_71iPt___ Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-----_____._____yj 1 ❑ Number of lines-----------------------------------Length of each line------------_--- ` --------------Width of trench ` Type or fiiter material-------------------------Depth of filter material------------------------ length---____-_-________--_-.._ Seepage Pit: Distance to nearest welly----Distance ;fpbm fc dation_ -_(f...........Distance to nearest lot line_-_j_7_,___�__-__ Number of Ffs_-----I.___---____.Linin materia .. p 9 ^"rh Size: iameter ----Depth--------- b Cesspool: Distance from nearest well-----------------Distance from foundation------------------ Lining material _____.-.____-..________- __.___.__. ---------------Depth-----------------------------------------------------Liquid Capacity---------------------------gals. 1 ❑ Size: Diameter----------------- - -- Privy: Distance from nearest well_--____________________________________________Distance from nearest building-____---__.__--- ❑ ---_-- _ .,..�"_ Distance to nearest lot line---------- - y Remodeling and/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, State ws, and ules and reg�Ians' the San Joaquin Local Health District. (Signed)•----------� ---- ---------------- - (Owner or Contractor] ,,� i �% BY: --• -----t----------------•-------------------------------------------------------------------- Title { - ' {Plot plan, showing sue of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--< --- -------------------- ------------------- DATE _ REVIEWEDBY. - --------------------------------------------------------------------------- DATE ----------------------------------- - ------------ BUILDING PERMIT ISSUED------- ------------------------------------------------------------•--------------------. DATE_-_-!_ Alterations and/or recommendations-------------------------------------------------------- -•----------- -----------------------•-------------:------•------------------------------------------------------ •---------•--------------------..----- -•--------- •---------•-------------------- ------ 71 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