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\ APPLICATION FOR SANITATION PERMIT tt, Permit No. 3_ • . .. (Complete in Duplicate) 3 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.3A.9Q--N'---I$_IA,"jA---- ----------------------- Owner's Name--- -----I'-Xx-v.) - -------------------------------------------- Phone----•------------------------------- Address--------... T ►.�l .....-�3- "- � T1 c.S----Q---t-�----------j-----C..-'.------------------------------------------------------------------------------ -------_----- -------- --------._. Phone--77-F6-Q-7------- Contractor's Name. )-'- -------------------•-------------------- Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/.____ Number of bedrooms __/___ Number of baths ._L___ Lot size ------------------------------------------.________-_______ f� Water Supply: Public system ❑ Community system ❑ Privatejk"*Depth to Water Table ZC7_ ft. b Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [-❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ 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 w61-00.......Distance from foundation----/. .______.Material.-Coticc_._O—R.tiC 4K.____.______- ❑� No. of compartments_..--, ----------------Size_/b-'------------------_--Liquid depth--9'------------_ _---Capacity--704 -C ------ Disposal Field: Distance from nearest well-- .0 0.. .._Distance from foundation___-� _ -_-...Distance to nearest lot line_________________ Q� Number of lines-------------- Length of each line___.7ti2 _ ._.Width of trench-___%2.9.................... Type of filter material.__ _______Depth of filter material----/_2_'.........Total length---------/.4a__-------------------___ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__________.____._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------------- Cesspool• Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- El _-_-..__________.-_- _-_---__.__.__❑ Size: Diameter-------------------------------------Depth-------------------------- -----------------------Liquid Capacity---------------;R---=---:--gals. Privy: Distance from nearest well-------------------------_------__---------------Distance from nearest building____-____._____.___________-__..____._. ❑ Distance to nearest lot line-l----- ------------------------------------------------------------------------ --------------------------------------------------------------- Remodeling and/or repairing (describe):______---M-C�.U1----��y.3_'f_ M_______________________________ ------------•------------------------ -------------------------•--------------------------------------------------------------------------.-----------------------•----------------..---- ---- -- --------------------------- I 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. (Signed)------------ IM-Iwr-- ------ ---Owner and/or Contractor By:...... s >_-, ------------------------------------------------------------ c;'-- (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 APPLICATIONACCEPTED BY-R--- '�----------- ---------------------------------------------------------------------- DATE��--------•--------------•------------------------- REVIEWEDBY = - j--- -- ------------------------------- -------•--------------------------------------._ DATE �, BUILDINGPERMIT ISSUED--------- -- ---------------------------------------------------------------------------• ---------- DATE------------------ - Alterationsand/or recommendations:---------------------------------------- --- - -------------------------------•-----------------••-----•-•--------------------------•------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.. Date M ------------- 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