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a� 5 APPLICATION FOR SANITATION PERMIT Permit No. ._ `_. -� (Complete in Duplicate) Date Issued Application 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-------.5._/-,��.!�O_-_o1Ule`t� �/f V t'r ..l- ....-••............... Owner's Name----------------------------------------- -1li-41'e ,------ / -�t2/51-f2---------------------------------. Phone Address.....................-------------------•--•------ 9/77_e Contractor's Name ----------------------------------- Phone....1?:n. 6 7 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ----- Number, of bedrooms Number of baths --- Lot size --- ----•-�---•-- .,�- ' Water Supply: Public system ❑ Community system E] PrivateX Depth to Water Table,:z90- ft. ---_-- - -- ----•---•--------•-- - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe% Hardpan ❑ Previous Application Made: Yes ❑ No.9 New Construction: Yes$ 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_/0fl-'-__Distance fro f undation__1 _~__-_--.Material- a•��_. No. of compartments_-. If F"" sr ----------------Sized--- x -Liquid depth_-?-0-- --........Capacity....... / �►�' _ Disposal Field: Distance from nearest well-/O ---- A Dista clfrom o ndation...-_./__40._--.Distance to nearest lot line------- I Number of lines-------f______-- Length of each line----- -_4''-------------Width of trench--- ' Type of filter material... -_ ---Depth of filter material---_.-__/"__�`� Total length...................... Z'-11------__ Seepage Pit: Distance to nearest well-------JC-A.".-_Distance irom,4ounclafion___.f,_ s ... Distance to nearest lot line.-..• ._ C9 Number of pits------/-------------Lining material__ We: Diameter _•-------Depth-_- -Q Cesspool: Distance from nearest well-----------------Distance from foundation-- --- _:.Lining material_ FI 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 hereb rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t to laws, nd �ru�land reg lations of the San Joaquin Local Health District. (Signed) - ----- Co tractor) By-........................................................... (rile) •----- -- ---- --- -- ------ - �.ide)��(Plot plan, showing size of lot, location of sys in relation to wells, b dings, etc., can be pl cad ?onreverse FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- DATE------------- _�.. ._G_._ REVIEWED BY . ---------- - - - _ _ , --------------------------------------------- -------------- DATE------------------_------! -"`S_ BUILDING PERMIT ISSUED_______________ _______ _ •--------- `-----------•--- -----------------------------•---•----...------......--•---------.... DATE---------- Alterations and/or recommendations------------------------_-__-_- ------------------------------------------------------------- --------•----------------------•-------------•---------------------- --------------------...... ------------------------------------- ------------------•------------------------------- ------------- ------------------ -------------------------------------------------- ------------------------------------------- FINAL -----------------------------FINAL INSPECTION BY:. ) .Y _---- Date. _ 1 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 10-52 Revised W-2100-