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.< APPLICATION FOR SANITATION PERMIT -- Permit No. __1016------- (Complete in Duplicate) Date Issued MOO �- 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 L CATION____.o_______ 1 Phone--- -5 ---------- Owner's Name------- ---- ------------------------------------------------------------------- Address-..., ---- ------------ --------- } ' --------------------- ------------•------------------------------- Contractors Name-------------- ------------- Phone Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---- Number of bedrooms -0-L Number of -aths ----( Lot size -------LAW-Le__ _-------------------- Water Supply: Public system ❑ Community system ElPrivate epth to Water Table 41ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe POOO'Hardpan ❑N-�11 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 feV O Septic Tank:. Distance from nearest well_69_� istance from foundation__________rMterial___----_____-:________-_---___________________--- ❑ /�/ Li uid d ------------------Ca acitNo. of compartments Size-- --rl q Capacity { r Disposal Field: Distance from nearest well_:- (_.Distance from foundation_____ 6_.__--Distance to nearest lot line______ ________ 1 ❑ Number of lines--------------- ----- ----------Length of each line-------------7-1-t- -----Width of trench---------- q --------------- e Type of filter material---------,-�1-r�1''-Depth of filter material_______----__-p Total length----_______7l_____________________ 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____________-_______.___________._.__. ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity---------------------- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-____________--______-___---------_----. ❑ Distance to nearest lot line---------------------- ------------------------------ "-------- - ------ - --------- F Remodeling and/or repairing (describe)__________ ____ _ P ' - ..- - - -- —---- ----------------------------------------------------------------------------------- I -- --- - I hereby certify thaf have pre ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an regulatio of a San Jo quin Local Health District. - ------- -----------------------------------------------------{Owner and/or Contractor] (Signed)-------------- ------ --- ---------------- 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 �-- ---- W� 71/---------- APPLICATION ACCEPTED SY-------- ------------------ ------Z-� ------------- ------------------- - -- DATE-------------I/< / E REVIEWED BY--------------------------------------------- DATE j --------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------= Alterations and/or recommendations:-----=------------- ------------------------------------•---------------------------------------------------------••------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ = --------•---------------*--------------------------••-----•----------------------------•--------------------•--- --------------------------------------------------------------------------------------- -----------------•-1------------------------------------------------------------------- ------------------------------ 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 C ES-9-2M 8-51 Revised W-2100