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-� Permit No. frh APPLICATfON FOR SANITATION PERMIT 10 p (Complete in Duplicate) —Date Issued 4 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. i - -- - --------------•----------------------------------------------------- JOB ADDRESS AND LOCATION_:--------1.- . `/� � � / ��d� rfi�, ---- Phone--,5— Owner's hone- f Owner s Name_ ---- -1 _. _.—--•-- ------- ---------------------------•------------------ •- Address_.. -------------------------------------------- ' Phone._- 9 Contractor's Name--------------------------•------= ---- -- -�-� -...----•---- --------------- ---- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: Number of bedrooms-.- Number of baths Lot size ---------16 `71___K-J 47----------------- Water Supply: Public system El system jX Private ❑ Depth to Water Table ____ �t. ' 4 Character of soil to a depth of 3 feet: Sand E] Sand Gravel ❑ y Loam ❑ Clay Loam ❑ Clay El Adobe og Hardpan E] Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No ❑ � '7v TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 #eef.] Se tic T k- Distance from nearest well________________ Distance from foundation-------------------Material------ _-_____.,___________--------------= No. of compartments Size -------..Liquid dep.Ah-------- ------------�Capacity---------------- ! f isposal field: Distance from nearest well________________Distance from foundation .-Distance to nearest lot line_______.________. Len th of each line------------------------- ---Width of french------:---------------------------- Number of lines--------------------------------- g Typeof filter material-------------------------Depth of filter material----.-----------------7otal length------------------------------------------ Type fro foundation___�_ei�._______Distance to nearest lot Seepage Pit: Distance to nearest well abv_w_ --- �`� r "3 btNumber of pits------/--------------Lining material-C-C&—lis- --.Size: Diameter-iz_- -- --------Deptn__.:�i-,�----------------- Cesspool: Distance from nearest welL___ __________Distance from foundation--------------------Lining material----------_-------------------._____ Size: Diameter------ -•--------- ------------ ------Depth-------------------------------------------------- Liquid Capacity gals. ❑ ,� _ --------------Distance from nearest building-=-------- ------------------y---------- r Privy: Distance"from nearest well.----;----------------- ❑ Distance to nearest lot line----------------------- _ --------------•-'----------- •------------------------------------------------ - Remodeling and/or repairing (describe):--------------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------- ------------------------------ ----•-----------•----------•----------------------------------------------------------------------------------------•----------------- ------------------------------- 1 . 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 re ulations of +he San Joaquin Local Health District. 4 ' ..... Contractor) = C or) Si ned ll -- ----- 9 I on • l 04 --------------------------- (Plot plan,-showing size of lot; location of sys# in rela+i to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �- APPLICATION ACCEPTED BY-- ------------------------- " DATE REVIEWED BY----------------------------------- ---- ------------------------------ --- ----- -- DATE------------------------------------------------- ------ BUILDING PERMIT ISSUED--•----------------------- -----___--------------------- -- Alterations and/or recommendations.................................. ecommen ations-------------•-------------------- - ---------------------------------------- -----•------------------------------------ FINAL 'INSPECTION BY:__.' _ -- _ --- Date_._ --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac , California Stockton, California Lodi, California Manteca, California Y E5-9-2M I0-52 Revised W-2100