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+� APPLICATION FOR SANITATION ,PERMIT Permit No.` �._ `"...... (Complete in Duplicate) dd Date Issued/Vtl' .2 .. Application is hereby made to,the San Joaquin Local Health District for a permit to construct and install the work herein described. Y This application is made in compliance with County Ordinance No. 549. Owner's Name AND eCAT10N.. w Phone_ Address T .... .....)v.)4 ........... --------------------------------------------------- ff '""" Contractor's Name----- --------- ------------•-------------------•-••--•------ - •••- -- ___ --------------- Phone: .._-_•--- -•-- :__..._---•-- Installation will serve: Residence ReApartment House ❑ Commercial ❑ Trailer Court ❑ Motel❑ Other-❑ Number of living uei#ss.. ,,:_ Number, bedrooms __ .-Number of baths_------- Lot-4iv _._--- -............----•_- ---_---------- _. Water Su -- pply pttbl'rc;system ❑ Community system ❑ Private Depth tp Water Table �t___- ft. !. Character of soil fo'a depth of 3 feet: Sand ❑ Graver❑ Sandy Loam X Clay Loam ❑ Clay❑ Adobe❑ Hardpan Previous Application Mader Yes ❑ No ❑ New Construction: Yes ❑ No ❑ • TYPE OF INSTALLATION AND SPECIFICATIONS: (No sep#ic tank or cesspool permitted if publisewer is available within 200 feet.) Se tic°; brsl:: Distance from nearest well__, ___:Distancap from ioun bion_- ----------Mateal- ' No. of compartments....------ -___-_....Size-- -.--- _ .-Liquid depth--_''V---------------Capacity--+8i.,_ .......... Disposal Field: Distance from nearest well____© __Distance from foundation tOQ __.Distance to nearest lot,?lin Number of lines__ ___ Length of each line--------r _M Width of trench Type of filter material-_-X Depth of filter material.....s _----.---Total length--------- ....................... _ __________________ Seepage Pit:. Distance to nearest well_____ _______________Distance from foundation__._______________.Distance to nearest lot line---------------- Number __.__-_______-Number of pits----------------------Lining material--- - --------------Size: Diameter------------------------Depth -------__ ___-----_------ Cesspool-, ---- ___----Cesspool: Distance from nearest well------------_....Distance from foundation__________ .Lining,-material;_------------ _-____-___________ Size• Diameter-.:-- Depth -x _, r- -Lrqu�d Capae�#y_ ---.: .----: gals.. Privy: Distance from nearest well------------------------------------------------- g___-_-- ---:----- Distance from nearest building ............................... Distance to nearest lot line'----- --- ---- ---- ---- ---- •------- -------- -------- ............ Remodeling and/or repairing (describe)------ --------------------------------------------------- --- --------- -------- ------- ----•--- ---- --- - -------•---------------- ---------------------- --- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,'Sfaf aws, and rules an latio of the San Joaquin Local Health District. (signed -- ------------------------------------------------------------ -----------------------------(Owner and/or Contractor) �Y-_........... •---- - - -------- -------------------------------------------------------------------- ---------(Title)--------------------------------------- -- --- --------- (Plof pian, showing,s>;u4 of lot, location of system in relation to wells, buildings,etc., can be placed on reverse:side). FOR EPARTMENT E ONLY }sf?LICATION ACCEPTED BY__ _ � -- -_�_-- ---------- DATE � - _ __ :�. BUILDINGPERMIT ISSUED--=-. -= --••--- ----------------- ------------------------------------ ..-_ DATE-........ ----------------------- ------•-=---•---- Alter tions and/or recomrnertds#ions; --•------ ------------------ - ........................ .. -= --------------------------------- -•• ----•-------- -----------------........- ------ --.•-..........................." --- •--------- ---- - ----------------------=--- ........................... ----------- • ------ -- .�, t q FINAL INSPECTION BY.--- ------_----------------------- Date--- ------- --Q_ SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street 300 West Oak Street 132 Sycamore Street 814 Street ° Stockton, California Lodi, California Manteca, California Tracy, �is 8-9—W 8=51 Revised W-2100