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07- IX APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) /4 Date Issued __..__../ . W. Applica4-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----/-_r�7.-/----- ---------------------------------------------------------------------------- Owner's Name.............. - ----- Phone - - ---- -------------- -- --- - Address......................... / �-----�----- ------------ ---- ----- ----- ---------------------I....................................................................................... Contractor's -,- Contractor's Name------------ 2__________ ___ _____� _ Phone_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I____ Number of bedrooms 3___ Number of baths ;? _ Lot size .........S�---* --_ ______________ Water Supply: Public system [Community system ❑ Private ❑" Depth to Water Table .7d ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej- Vlardpan ❑ Previous Application Made: Yes ❑ No ?�'_ New Construction: Yes ❑ No 29--' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , i Septic Tank: Distance from nearest well_ Gn _Distance from foundation..../d_--_____.Material...�_4z----- [ � No. of compartments-----a�-_-----..---_Size___SL___ c6i_.___Liquid depth_--lcz_D__._--------Capacity... ,0_Q__ Disposal Field: Distance from nearest well 22CYA--'Distance from foundation_._.ld.1..._Distance to nearest lot line......... 9-01" Number of lines________ __________ g �� QQ -- _n. _. Length of each line______�G__ ._.��._...Width of trench._._._. �______________________ Type of filter materiaLj45'_- r_k_Depth of filter material__.__ '_._____._Total length_-_- e___________________________ Seepage Pit: Distance to nearest well__�) -J9—___Distanc fr m upd tion----- Distance to nearest lot line...... Number of pits.-.--_-Z----------Lining materia=i`A�ze: Diameter----Z:?. -------- Depth-..-- -4'r________________ Cesspool: Distance from nearest well----------------- from foundation-------------------Lining material_-__.__------_-_----._----____-_____-. ❑ Size: Diameter--------------------------------------Depth----•-----------------------------------------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well___________________ ____________________________Distance from nearest building._---.--_--__.----____________-__-___-_._. ❑ Distance to nearest lot line-------------------------------------------------••-----•-----------------------•------•---------•-----------•------•----------------------- e - Remodeling and/or repairing (describe):-----la.lf----YMY- r ----•-------- ----- -- ----------------•--- _--•-----•--------•--_-- --- ---------------------• (/ ---------•-- --••-•--------••---•-•-•---••------------•-••--•----- ------------...............................................---------------------------------------------------------- ------•--------------•--•--------------------•--•---------•--•---••----•-•-----•------------------------- ---------------•----------------------------- - •---- ----------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5 t laws, and rul=dregulations of the San Joaquin Local Health--District. (Signed).. -------------------------------------- --------------- (Owner and/or Contractor) By:---------- ----- lrtle)._. (Plot plan, showing size of lot, location of syst m relation to wells, buildings, etc., can be placed on-reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --- ------ - ----------- -- ---------•--------------------------•--- DATE.----4 ---- - REVIEWEDBY --------------------------------- -- .................. DATE---------- - . ..................................... BUILDING PERMIT ISSUED------------------------------- - ----- ----------------------------------------------------------- DATE .`-----------------------------._..._ Alterations and/or recommendations:................._ __ -_. _.--_ \ ` ---------------------------------------------------------------- ----------- ----------- -- ---------•..................................................................................................................... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------ ------- ----------•----------------------------- -------- ------------------------------------------- ----- ------ -------•------------------------------------- ------------------------------------------ ------ ---------------------------- ------------------------......----------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----- = --- --------------- Date----------------�L)-------------------------------------:------------•---- 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 145446 ATWOOO