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� 3 APPLICATION FOR SANITATION PERMIT Permit No. 7 �------ -••---- --- ., (Complete in Duplicate) JJJ Date issue �. I3 � 1 Applicati,,K is hereby made to the San Joaquin Local Health District for a permit to construct and install the work rein described. This application is made in compliance with County Ordinance N . 549. JOB ADDRESS AND LOCATION_____ - • ® , - _ n/ Owner's Name ------------- ---"- ----�- --- --�--•---� ---------- �- � f��' - Phone---- Address_ Contractor's Name----------- -------------- ------- ------ ------------------------------------- _........... .. � ---- --- ----------- Phone_-7 Installation will serve: Residen a X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: --/._- Number of bedrooms�.� Number of baths_ iE..--r Lot size ---------� 1, ❑ Other ❑ - ------X-- �� Supply: Public system � -�---- ------------------- WaterPP y y 5d Community system ❑ Private I] Depth to Water Table 7. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Mads: Yes ❑ No 16 New Construction: Yes 9 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-A0 ----Distance from foundafion_1 0 martments- P / 3Liquid depth- 4-A Material_ -_� C-��-.----.--- No. of co _ry " �� .- Sizes sc. ---------- _ " Capacityf�dd_ Disposal Fiefd: Distance from nearest weil__kc� ---Distance from foundation--_-�_- ---"---_Distance to nearest lot line �, Number cf lines-----I--------------- -- Length of each line_v[l---------------------Width of trench..+ .51---------------- Type of filter materiat.__>✓X—. }- -Depth of filter material ---".--- .---- otal length----34: r-_ Seepage Pit: Distance to nearest well -_f`Lc+�i f"--- ateriace fro f undation�Q_'_-___ Distance to nearest N Number of pits-_-"_ -_-----__---Lining material Size: Diameter_.--f__ � Cesspool: Distance from nearest weft_..- ��- '� Depth_, .� --_-- ---- __Distance from foundation--- --------------„Lining material---..___-__._--------__.-__--__” ❑ Size: Diameter_ ------ -------- - ---- - ------ Depth-- ------------------------ Liquid Capacity-------------------- - ---gals. Privy: Distance from nearest well -------- Distance from nearesr buifdin ❑ Distance to nearest lot line. g___- -------- ------ ---- -- ------ ------- -------- Remodeling and/or repairing (describe):_'-_-_-�.s��,..__ �r _ '� � ------ -- � --------- -- -------- __ �t "- ---------- -- -- - -- _---a--- ! hereby certify that I have repared this application and that thork II b doe n accordance wi5 � ordinances, Stafe law , nd rules and regula ns of the San Joaquin work n J uin County q 1 Health District. (signed)-____-- C� / ----------- ---- - ontr cfor) By:--------------------------------- ----------------- - ----- - --- -- -- - -- -- - --- --- - -{Tiffs)-- - � (Plot plan, showing size of Cot. location of system in r i tow Y building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- r REVIEWED EY----------------- DATE_. J BUILDING PERMIT ISSUED -------------------------- - - -- --------------- - ----- - ----- ------------ -- -- A terafions and/or recommendations: __ ------ DATE------------------------- ---------- ------ ---------------------- FINAL --- ---------------------------- F1NAL INSPECTION BY:...... .--- 7 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 Manteea, California Tracy, California ES-9-2M o-52 Revised W-2100