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`.1 q 14 Permi . .. f..._..APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) G / Date Issued 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 A CATI �y -- ........... -- Owner's Name---•--... •.-•-1---- -.t--------- / ------••--------- - --- ----- Phon - -- -- ��?5 Address / _ �jt'` -� � �.4--------- �----------- �r , Contractor's Name-------_--------------- c:.�-^r' - `� ... Phone, d r1' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: •_-/ Number of bedrooms ;;;?� Number of baths /_ Lot size ------1,5_ 46 Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table SD ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ No� New Construction: Yes ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta . Distance from nearest wellJ _i-----Distance ro foundation.. -....M�ate',al______:.___ ._ 9?000No. of compartments __-______Size..`...�- 3Z_-___-Liquid depth ____--_Ca aci d _ �v� P tYp Disposal old: Distance from nearest well__V_Q_�_ __Distance from foundation `5 '.._.Distance to nearest�ot line.---�_ ..... Number of lines________ _______ Length of each line_____D_' a--_...Width of trench•_-�--2.0'_._-_-.____________.___ Type of filter material.S1__ __Depth of filter material-/Z11..........Total length..........oZoZ.O------------------ G\` Seepage Pit: Distance to nearest well____--_______________Distance from foundation....................Distance to nearest lot line----------- El Number of pits______________________Lining material-----------------------Size: Diameter------_--------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------.___________. -, pSize: Diameter--------------------------------------Depth---------------•----------------------------------.Liquid Capacity-----------_-_-------_-gal Privy: Distance from nearest well______--_---------------------------------------Distance from nearest building______-._-__--________----_______________- ❑ Distance to nearest lot line.-------------------------------------------------------------------------------•--•----•--------•-----•-----•_----------- Remodelingand/or repairing (describe):-------------------------------------------------------------------•----•--••-----------•--•--•-•-•-••-••---•••---•----•••-•---•--------••--•------•--- -----------------••..._..------•---------••---•--------•••-----••-----••-•---•-•--•--••---•-•-•--•---------••--•---------------------•-----•-••••--•••--••----------•••--•-------••-•--•---...----------•--------•------------ . J --------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---•----------------------------------- I hereby ertify that I have prepared this 'application and that the work will be done in accordance with San Joaquin County ordinances, t e laws and ru nd regulati sof the Joaquin Local Health District. 5 (Signed)----- ------t---X__ •--------------- ------------------------------- ----e_.�- ner and/or Contractor)% By:•--•--•-----••--------------•...•. • !- -- ------ -- . (r+le)--- - ------ (Plot plan, showing size of lot, location of system in relation t ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- ---- .._-------------------------------------------••-------•------- DATE--- REVIEWEDBY------------------------------------- = -- ----------------------------------------------------------------- DATE......... BUILDING PERMIT ISSUED________________________ . DATE.._____.._ _� . ----- ----------- ------------- - --- - Alterations and/or recommendations-------------__---- -----••----------------•-•-•-•---------•-.....---•---•--------•------•----------- •-- ------------------ ... _.. -•--------------------•------------ -------------------•---------•--------- 1,- '� _ _....•---- .-- ----------------------------- ------------- .. ----•---•-----------------------•---•--•---------------- FINAL INSPECTION BY: - Date l-9. ' "�= " -------------------------------•---- 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-9-2M ; Revised W-2100