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�.e .y _/ �o �► (! APPltCATION FOR SANITATION PERMIT .�.,� .-� � No�_ •- -!�- r (Complete in Duplicate) s Date Issued - . -- UU _ � Application is hereby ma a to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS LOCATION - ----�- f` c� .. Owner's Name - tl. --- - Phone 7-- b...... Address---- - ..... . ... -•---- ---------- ------------------------------ Contractor's - - ------ -Contractor's Name..... ------- ------• -- -••--- --------------------- - ------------------- ---- -- ------- ------------_------- Phone --•-- --------._....-- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: J--- Number of bedrooms _Z__ Number baths .,&- Lot size __,__- Water Supply: Public system ❑ Community system '❑ Private ' Depth t Water Table s----- ft. a Character of soil to a depth of 3 feet: Sand Gravel❑ Sandy Loam Clay Loam ❑ -Clay❑ Adobe Q Hardpan ❑ - Previous Application Made: Yes ❑ No New Construction: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public srer is available within 200 feet.) Septic ank: Distance from nearest well____ GY _Di5#a rom founds' n---1___ ........Materi -t------ ' i --------- 's No. of compartments---------- -- --------Size_----X_I! Liquid depth_-_----__-��___-------C apacity...,�_S� i�-- / Dispos Field: Distance from nearest well � -_.Distance from foundation _Q ___Dis#ante to nearest to�jhne � ' Number of lines__-----4-_-!__ Length of each line_________/- Wid#h of trench___.-__/5� . _. f ,��p�Type of filter materi __ �A�'-lllepth of filter material-------.-_ _-__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: Distance from nearest well-----------------Distance from foundation--------------------Lining material_- _._____.-------------__-____. ❑ Size: Diameter........._--- ------Depth----------------- -------_--------------------Liquid Capacity --•--• ------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______ ---------w----------- ------------ El _____.-_ _..__._-: Distance to nearest lot Tine------- ------------------------------------------ ---------------------------------- - ------ •--•-_- -•-------- --•---- -- Remodelingand/or repairing (describe):.................................................................................................................................-------................- -------------------•-----------------------•------------------------------•------------ -•---------------------- ---•- - ------ ------- -------- - r I hereby certify that 1 have prepared this application and that the work-will be done in accordance with San Joaquin Couaty- ordinances, Stat laws, and rules and,regulations of the San Joaquin Local Health District. (Signed)---------- --------------------------------------------- ----- ------------------------- -- _(Owner and/or Contractor) 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-14.e- REVIEWED BY- DATE BUILDING PERMIT ISSUED--•- ------ ------ DATE.. ...... ' Alterations and/or recommendations:__--------------------------- FINALINSPECTION 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 8-51 Revised W-2100