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r1< "7 - APRLICATION FOR SANITATION PERMIT Permit No. ...... (Complete in Duplicate) Date Issued ------�.��-J�--�3 AWi � reby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Tis made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION .- rrd � i! '�i ._ .. •__ _ ...... - -Owner's Name---- ---------- -- - -- -- - --------------- --------------- ---- ------ -- Phone.0144e: .f_-MT• Address........ . ....... 3 . Contractor's Name...._....... -----_- __:. Phone_ �f Installation will serve: Residence Apartment House ❑ Commercial -❑ Trailer Court [ Other, ' y ❑ ___ Nurnber of bedrooms Number of baths .�*Lot size _.af_ .___._.__Number of living units: __/ Water Supply: Public system ❑ Community.system [Private ❑ Depth to Water Table -___- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous ApplicationMade: Yes ❑ No New Construction: Yes 5RI"No,❑ TYPE OF INSTAL LATION AND SPECIFICATIONS: (No septic"tank or cesspooLpermifted if public sewer is available within 200 feet.) __ _ J* Septic TankY Distance from nearest wellD_ll ,r __Distan a fram foundation Mater' __ _. No. of compartments______ _______9'.-____Size :, � _ ' Liquid depth _.s ------Capacity_ .. Dispo field: Distance from nearest well-__-'-'Q0---_Distance from foundation....... Q..___.Distance to nearest lot,hne Number of`lines............. _ __ Length of each linen._ $`0°��____-Width of trench. 'off' Type of filter material_ ---- ____ -Depth of filter material_______ g _Total length-------ZAM __________________ 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: bran; w ---Depth------ ....Liquid-Capacity: _...g Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building____-_______---_ ---___-__-_.___:____. Distance:to, nearest lot line-----------------------------------------------------------------•------------------------------------------------------ Remodeling --- •-Remodeling and/or repairing (describe):------------------- --------------------- ---------------•-----------------------•-•-•-----------.......................................................... -=--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------- --------------•--------.._....•----•---•---------•------•--•-----------•••--•-•-------•---•----•--•--•----------•--------•-------------•--•-----•----•--•---------•--------------------...---------•---------•--•-----------•. ------------------------------------ -----------------------------------------------------------------------.................-----------------------------------------•------------------------------------------------------ 1"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. (Signed) r _".7Z----••------------- ----------(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 ACCEPTED BY _. __ .___ DATE__, ---------------- REVIEWED BY .�. DATE_. „"�,�'` -- - -Bt tD NG PERMIT ISSUED---- -------------------•------• - ------------- ........................ .................. DATE.. ••------ Alterationsand/or recommendations:--------------- --------------- ------------------......................................----•--•----------------•--•--•--------•----•-•-......---•---•-- -•---•----•-----------------------------------•--------- ------------------------------------------------------------------------------------------- -------------------..................................................... --------------------------------------- , FINAL INSPECTION BY:----- _' t -- ---------- 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 y ES-9-2M 10-52 Revised W-2100