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f/ 5� APPLICATION FOR SANITATION PERMIT Permit No. 5____ _____________ (Complete in Duplicate) j 33 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. / C ------------------------------------------------------- JOB ADDRESS AND L ATIO - �P 7---I ----------- ------- -- = �Y ------------------ -------------------------- Pon Owner's 'Name-- L s ---•------- ----- T11�� ----- � ' - t ----------------- Address •-- p /__.. Contractor's Name !K?'-'_ � -------------- -----5 -- --- -- - -------•--------- ------------------------- Phone___7L. 4_& ----- Installation will serve: Residence R"AApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __1.. Number of baths ___/__ Lot size ___ -Q-I---__. __IGr_- _______________________ Water Supply: Public system ❑ Community system ❑ Private dDepth to Water Table YO ft. Character of soil to a depth of 3 feet: S;��New Gravel E] Sandy Loam ❑ Clay Loam E] . Clay ❑ Adobe Hardpan F]Previous Application Made: Yes E] No Construction: Yes ❑ No l-7 W TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material ___.___________._____-_-.---.-------..-.-___-- V ❑ No. of compartments--------------------------Size---------------------------- ---Liquid depth--------------------------Capacity------------- -------- Disposal said: Distance from nearest well------11-15.-"Distance from foundationDistance to nearest lot linte � Number of lines Number Length of each line----------._-�40-- ----Width of french_._. .a�T-__.._...______-- Type of filter material__1� N--___Depth of filter material_._..___�u`______..Total length______ _hV_________________________ Seepage Pit: Distance to nearest well--------------_-------Distance from foundation-------------------Distance to nearest lot line, ____ __.___ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------,------Deptn--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________.__.-------.____.____.._____ ❑ Size: Diameter-------------------------- -----------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest builcling------------------------------------------- ElDistance to nearest lot kne---------------------------------------------- ----------------------------------------------------------------------------------------------- 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, St a laws, and rules and regulations of the San Jo quip Local Health District. 1l- .t__ - - ----------- ------- --------- and/or Contractor} (Signed) gY= ��' -- - (Title)-- (Plot plan, showing size of lot, location of system in rela io o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------- ---------- ----------------------------------------------- DATE - -------------------------------------------------- REVIEWEDBY------------------------------- -- ----------------------------•----------------------- DATE-- BUILDING PERMIT ISSUED-------------- -- DATE ---------------------- Alterationsand/or recommendations-------------- --- ------------------------------------------------------------•-----------------•-----------•------•-•-----•---------------------------------- --------------------------------------------------- -------------------------------------------------------- ---------------•------------•-----------•---------------------------------------------------------------------- ------------- ---------------------------•----------------------•--------------•--------------------------••--•-----------------------------------------------------------------•---------------------------•-------------------------------------------------------------------- ----------------------------------------------•------------•------------------ -----------------------------------I----------------------------------------------------------------- --: -------------------------- ---------- --•---------------------------------•------------------•------------------------- --- ------------------------------------------------------- - FINAL INSPECTION BY-------- --------- - -------------------------- Date----------- 7 7 a 1/ 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 10-52 Revised W-2100