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APPLICA (TION FOR SANITATION-PERMIT Permit N (Complete in-Duplicate) 10 Date Issue �,.. _ :51_ Applica-ion 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_ -L_-.�L__talj�,4 __. _'�' ... Owner's Name.---- -_ : ----------------- ----- . Phone A4S�TQ Address__�S_ .....�1d dye�...... ----------•------•---•------•-- - Contractor's Name.......... � ` y- -------------------------------------•------------- ---------•----------- Phone. --- + Installation will serve: Residence gj-�_Apartment House ❑ Cgmmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j--- Number of bedrooms ---!F. Number of baths I.__ Lot size -----•`-5r :------------- Water Supply: Public system ❑ Community system ❑ Private depth to Water Table '41' 4_ ft. Character of soil to a depth of 3 feet: Send ❑ . Gravel ❑ Sandy foam ❑- Clay-Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: Yes ❑ No [B,"�Ikew Construction."Yes 2�rNa❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Ta k: Distance from nearest well__�� Distance from foundation___�0__�_____.Mate I----------------------------------- Septic __ _. No. of compartments---_____'L"-------------Size..."Xgr ----------Liquid Idepth_.__y3-----------Capacity---I v,. Disposal F' Id: Distance from nearest well -_Distance from foundation Ad__ _._____,Distance to nearest lot lineia-9 Number of lines_________ _ ___________p_ __Length of each line____.___---s-__________.Width of trench.....0'2_f_----______ ____.____ Type of filter material-'C---Re. Depth of filter material � ��__.__,Total length_-_-.-__ `'� '___________________ Seepage t: Distance to neagot well,l-do4_,__Distance frofnkfodnxdafion __�d__ ._...Distance to nearest lot line ' _._ Number of pits-77 ------------ Lining material(!! ..Size: Diameter._.__, _ ��_-_--Depth-----�5_' Cesspool: Distance from nearest well________________Distance from,foundation--------------------Lining,material-------------------------------------- ❑ Size: Diameter--------------------------------------Depth---- ---••-•- ----------- - ------- ------Liquid Capacity....................-----•_gals. _Distance from nearest building Privy: Distance from nearest well 9 •----_---.� ❑ 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 regulation; of the San Joaquin Local Health District. ,.,;rr, (Signed)-------- (------ --------• •-------- ---------------------•-------- -------------- ............ (OW, rand/or Contractor) By:....................E..... --•--•------ __(Ti+le) --- - ------ (Plot plan, showing size of lot„ location of sy em in rela+ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY V APPLICATION ACCEPTED BY----------------------------------------------- -------------------------•---------•- DATE---- -------Z. .._:S' REVIEWED BY-------------------------------------------------- � -- ------------------------------..... DATE........................................................... BUILDINGPERMIT ISSUED------------------------------------•-•-----•••-------------------------•---•--•-••--•------------_._ DATE.---- Alterations and/or recommendations--------------_-------------- -----•-----------•-------------•------------•-._..._.--------•----•----------•--------•••--•----•--------•--•----- ............ --------•-----•--------------------------------------------------------------------------------- -•--•--•-----------•-------•-•-•-----•-•-•-.._...--••--•--____.-..._.__.- ---------- ------------------------------------------------------------------------------------- ----•------•-----------------------------•---••---•--•----- -------------------------------------------------------•-----•------------•--•---•---------------------------------------------••----------------•-----------••-••----••----••---•-••------------•-----------............. --- ----------------------------------------------------------------------................................................. ..................................................................... - FINAL INSPECTION BY:.,--------------- ...... Date.................. �- ••••••5.---/-----•--- .................. SAN JOAQUIN LOCAII, 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 Revised W-2100