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APPLICATION FOR SANITATION PERMIT Permit No. ,,31 in Duplicate) d 5'3 4 (Complete P ) p A��Q ( 0Date Issued ._... .f Q_ :S 3 iplication is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. No. 549. . JOB ADDRESS AND LOCATION..... ...._. .�zA' It*2_71-e-------- ..... ---------------- �L , Owner's Name---------------------------- � -�--------- ------------------------------------------- Phone------------------------------------ Address--------------------------------------------------------- �kv` ,� --------------------------•-•----•------ ----•-•••-•-------------•--------•----•------ Contractor's Name----------------------------------=-----------------------------------------------------------------------------------------------------_- Phone.................................... Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Pther ❑ s Number of living units: _/-..- Number of bedrooms _. -. Number of baths -_1... Lot size ,_....7:1-f ................ Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes Ej No ❑ 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--�-j- �_--._.-Distance from,foundsition--.-. 0--------- Materi5l---- ----------- ;?INo. of compartments.._...._.. -----------Size IQ..+R'+f.-X--1 :-..Liquid depth__.------5 ------------Capacity--/67290------ Disposal Field: Distance from nearest well--.,5-d---...Distance from foundation_,,-_......Distance to nearest lot line.J.......... 1 ® Number of lines------------A--------- -------Length of each line...9-40..� .�t� Width of trench- 4_. v.....-- ... ._-_...-� Type of filter material__S; 1 -Depth of filter material-----,/�..._---..Total length_-_.-_-_. -�.�L ___________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation...............°--..Distance to nearest lot line----------------- F1 Number of pits----------------------Lining material-----------------------Size: Diameter------i......---------Depth---.-._.--..--..--.---.-.._-----. Cesspool: Distance from nearest well---_-.-----_---Distance from foundation--------------------Luing material---------------------------........... ❑ Size: Diameter--------------------------------------Depth.-.-------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.------...-----.--------------._- ❑ Distance to nearest lot line-------------------------------------------------------------..-_---- ------------------------=-•-------•--•-------------------------------- Remodelingand/or repairing (describe--------------------- ---------------------------------------•--------------.....------------......---•---•----------•-------------------------------•-•- ------------•-------•----------------------------------•--------------------•--••---•-----------------•.----------------------•------------------------------- ----_------------ --------------------------------------- -------•------------------------------------------------ ---------------------------------------------------------------•------•------------------------•.---------;------------------------------------------------------- - ---- ------- -----------------------------------------------------------------------------------------------•--------------------------...................•--------. -----------. .. 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. C /fl 'V --- -----------------------------------•------------------------ (Owner and/or Contractor) (Signed) ------------ By:--------------------------------------------------------------------------------------------------------------------------- Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of systQm in relation to wells, buildings, etc., can be p ced on reverse side). O DEPARTMENT USE ONLY Ir P APPLICATION ACCEPTED BY------ DATE �> ----------- -_-- REVIEWEDBY------------------------------------------------------------------------------------- -------------------------------._...... DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------ -- - ---------------------------- TE----- ---------•------------------------------------ Alterations and/or recommend tions:...._ .. ... ........ -- � �, ---------------------------------------V :----- f-- _ r_1 � � �t ------------------------------------------ ----.....------------------•...-----------------------------------------------.------------....---------.......-----------------------------•------------------.---------- ------------------------------------------------- ..................................................----------------------------------- ------------------------------------------------------------------------------------- FINAL INSPECTION BY: �'-�`---------------------------------------- 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 Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100