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5 .� APPLICATION FOR SANITATION PERMIT Permit No. "- G---7....- / T u in Duplicate) 5 3 (complete Data 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. JOB ADDRESS AND LOCATION------ - -----.LD__ _ - '---y� = �j Owner's Name____�----_ -- - -- ----- ----------- ----------------------------------------- ------ Phone /}. Address. ��'`� -------------------------------------------pp----/----------7......... _=Z Contractor's Name-. .. = = -._ Phone._�_L- ---`------. Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court El MON', Other ❑ Number of living units: -f-- -- Number of bedrooms -- Number of baths _/-___ Lot size ____.. _ Water Supply: Public system E]—Community system [I Private [Depth to Water Table _ d ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay ❑ Clay E] Adobe [Hardpan ❑� Previous Application Made: Yes ❑ No 2" New Construction: Yes ❑ No © � TYPE OF INSTALLATION AND SPECIFICATIONS: �\ (No septic tank or cesspool permitted if publid sewer is available within 200 feet.) r p 1foundation--------------------Material------------------------------------------------" Sep Tank: Distance from nearest well_________________Qistanc from l Field: D stance from nearest wel{___._ J_C�__�Distance from_______ Liquid dept.:...........s_____..Capacity_____,---_______...�__ (1 No. of compartments ---Size-------------- -- Disposal / '�� }foundation------ ._ __ Distance to nearest lot line-- ___r--. L�1" i I Number mr-lines-------------- ,-`-lit- Length.of each-line---------- �_-- f� .Width of +reach----------4-;----------------. Type of filter material-__--16A- ---Depth of filter material_______.. ___.._Total length-------- --------------------f / 1�:1-._._Distanc/ to nearest lot line,---.I-D.-- Seepage Pit: Distance"to nearest wel{_._l--_��--- .___Distance from fou dation__,____,_ -Size: Diameter_-_.r,33._-'_._.Deptn.---r�15------------------ Cesspool: (�" Number"of pits___.___-1------------Lining material_��,_ _ ____ -------Cess ool: Dis a ce'froer_nea}est wei4----------------Defiance from foundation--------------------Lining material------------------------------.--_-__ P r " " th----------------------------- ------------------.---Liquid Capacity-----------------------------gals. � ❑ ,%4 0 r- R Privy: Distance from nearest yell------------------------------------------------Distance from nearest building------------------------------------------- ❑ Distance to nearest lot line--, T_- -------------------------------- ----------- Remodeling and/or repairing (describe}:-- -----------------------------------------------•-------------------- -------------•--=-------------••----•------------------- a w I f" ------------ ----------- ------------------------------------------------------ •-•-----------------•------- -• -- ------------------------------ I hereby certify +hat I have prepared this application and +hat'the'work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. a+ � (Signed)-------9 i = �- and/or Contractor] ------ By:---------- {T�t le) (Plat plan, showing size 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--------- �� 3--------- - ------ -- ---------------------- REVIEWED BY------------------------- ------ ---- -" ---------------------- DATE = -- - ------------------------------ - -- BUILDING PERMIT 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 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M 10-52 Revised W-2100