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./��) APPLICATION FOR SANITATION PERMIT I it No. _.(rt/I__ -------- I v (Complete in Duplicate) 3� Date Issued -----!• 5�-_._. 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-. � 1 ✓_ �,,( �4 Cl�iD.._ Owner's Name-- --• --1 !�-•0 ------ Phone------------------------------------ Address--------------------_--- = --•-•----•-•--- --------------------- -•-- . �4!!!.Sa!w,�iw Contractors Name.... ___ __`:R _ __ ____ _ _ ____________ ___ ,�± ---------------- Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -f---- Number of bedrooms __4- Number of baths .1.... Lot size ___________________ Water Supply: Public system °�`ommunity system ❑ Private ❑ Dep h to er Table .�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑• Clay Loam ❑ Clay ❑. Adobe ardpan ❑ Previous Application Made: Yes ❑ No P --J ew Construction: Yes ❑ No A.. . 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_________________Distance from foundation....................Material__•___.._______.___-_ -_--.._..______----__-----. No. of compartments--------------------------Size____----___-___.__--__--.-_,---Liquid depth-_-----------------------Capacity----------------------- sposal • Field: Distance from nearest well-----------------Distance from _ foundation__ ..___.Distance to nearest lot line---S`'!._____ Number of lines__________ __ __ __ �__ ._. .Length of each line...._ ........Width of trench---,�. %1~-_-___---._-__.____ Type of filter ma _Depth of filter material____ ___._.__Total length__40----------------_------------ Seepage Pit: Distance to nearest well----------------------Distance rom foundation....21?_!......Distance to nearest lot linej*.'_�-__-_. �} d+.-.., Number of pits------I---------------Lining material_- " _ _Size: DiameterJ- -'o-._-------Depth_._J411--.----------------- l Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__..---.-____-.__.___..__.____--_-.--. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----- --------------.gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__-_-_.___-__-________-.-_____-_____-__-_. ❑ Distance to nearest lot line----------------- ------- ------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):-----------------------------------------------------------------------------------------------------------------------•--------------•-------------- -----•---•--•-•...--•-•---•-----•---------••-------•-•......-••-----••------•--------•----••---•-------------•-----•-----------•--••-•----•----•-•--•---------------•------•-••----•-•--•-------•-••--------.----••-•-------- -----•-------------------------------------------------------•----------•------•--------------•---------------------•-------•-----•---------------------------•------------•-------------------.----.-.-.._...--------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and s and regulations f the San Joaquin L cal Health District. (Signed)..... . GOw+sw:Iwd�4" ontractor) ... ... 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 -- - - -- - - REVIEWEDBY------------------ ----------------- --- -------- DATE---------------•---•---------------...................... BUILDING PERMIT ISSUED -------------------------------------•---------------------------•----• DATE---------- -•--- -------------- Alterations and/or recommendations:-----------------------------------------------------------------------------••--------...----•--------------•-----------------------------••----•---- ..........................................................-------------------------------------- ----------•-•----•--•--....._...-••-•--•...._..---••----••--•---...------•--............................................... ----•----------------------------------------------------------------------------------------------------------------------------------------------------•----------•--------------------------------.............. -----------------•--------------------------- -----._..-.----------------------------•-------------------------------- -- --------------------- .............. ... --------------------------------------------------------- ----------------------------------------------------------------------------•----...------------------------•--•--------------.....------•--------......------ -------------------``------------------------ 10, FINAL INSPECTION BY:...- - ------------------....... Date..------._ -------f----------------------------------------------- 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 - W5