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APPLICATION FOR SANITATION PERMIT Permit No. 7_ - � � - (Complete in Duplicate) 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. JOB ADDRESS AND LOCATION-•-----•----.�'��- 1 W41 :---------------------------------------------------------- p _ Owner's Name----- �r '�r"'M !r +r.--- ..... -------------- ------------------------- Phone l Address........--• -------------------------------------------.-........•-----------------------------------------------•---------------------------------------------------- Contractor's Name---------------------------- •-----------------•-------------------------------------------------=---.----------------------------------------- Phone-.-------------------------------- Installation will serve: Residence V Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i a.. Number of living units: _. ., Number of bedrooms _ ___ Number of baths PZ--- Lot size X-94"47------------------------ I Water Supply: Public system Community system [I Private F] Depth to Water Table __'t___ ft. Character of soil to a depth . 3 feet: Sand ❑ Gravel ❑ Sandy Loarn ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No % New Construction: Yes K 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 weli__ Distance from foundation_._)0__________-Ma ferial__ UM-0W---- _____- !� No. of compartments_____--_�_----------size_ ___ l_`L Liquid depth..?XEZ�--_--Capacity..�Z� ____ Disposal Field: Distance from nearest weil_ istance from foundation__�________Distance to nearest lot line40 .___________ - +r { Number of lines___ ______________ Length of each line- ft 4Q Width oftrench__.��_-_ __--___-_____-__ r_ g �7- Type of filter mate ria l______-Depth of filter mate rial__-�� -- ----___Total length____R••�__:"�_�- Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------_--------Distance to nearest lot line_______--___----. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------------- 0 _-__.___-----------________________.❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------------gals. i� r Privy: Distance from nearest well------------------------------------------ ----Distance from nearest building------------------------------------------ ElDistance 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, State laws, and rules and regulations of the San Joaquin Local Health District, M {Signed) -------------- -----__e-`------ ----------------------------------------------(Owner and/or Contractor) By:-----------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (Plot 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 ACCFPTED BY------ DATE REVIEWED BY ---------------------------- DATE 7- A --- --- BUILDINGPERMIT ISSUED-------•---•---------------------------------------------------------------------------------------- DATE-------I------------------------- Alterationsand/or recommendations:---------------------I---------------------- -----------------------------------------------------------------•- •--------------------------------- -------------------------------------------------------------------- ------- ------I----------------- -------•-------------------------------------------------------•-------------------------•----------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------- ------------------------- --------------- ---------------------------------------------------- ---------------------- ----------------- FINAL INSPECTION BY: -- -- - �,_ ---------------------- `5 - ~G-��---------- --!rGate---- 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 B-51 Revised W-2100