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y r _ , APPLICATION FOR SANITATION PERMIT Permit No. _ _____-------- A 50 _______Ate0 I (Complete in Duplicate) Data Issued C111.=--�..-�.•--- A lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. fThis application is made in compliance with County rdinance No. 549, JOB ADDRESS P.N IOC BION-- - �- - � -�c'�l�_.. ----- -- - -• ------------------------------------------------------- f� � X Owner's Name - F ��------ -------- - ---- - Phone Address---- --- ------`-=-` '--------------------------------------------------------------------------------- Contractor's Name---- ------- - -- --------------------------------------------------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Molel ❑ Other ❑ Number of living units: ---L umber of bedrooms __2V_ Number of baths ___�-__ Lot size . _ ,- __________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand GravelEl Sandy Loam Clay Loam ❑ Clay ❑ Adobe [[Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes Er ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. � r� Septic Tank: Distance from nearest well --------Disian ��fr m anon_____c______________MaeJriaL____ _::_______ ....... __ ___ [V No. of compartments__________ _________Sizes2Liquid depth_______?-_.___________Capacity------ ---------- _ DisposaI Field: Distance from nearest weil__ ---------Distance from foundation_ ____'_ ___..Distante to nearest lot , Number of lines_________________� Length of each line_________ _ __---------Width of trench__ _++___ __#___________________ Type of filter materiaj- -.--- s_ Depth of filter material------- -----------Total lengthh----___------_--__ 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__-_-----_-_------_--------____._-_. ❑ Size: Diameter--------------------------------------Depth-.--------------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearer# well---------_---------------------------------------Distance from nearest building------------------------------------------ Distance ____-_______-_-__-______----- --_ - Distance to nearest lot line--------------------------------------------------------------------------------------------------------- -------- = ' Remodeling and/or repairing Idescribe)---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------•-- -----------------------------------------------•'----------------------------------------------------------------------------------------- ------------------------------------------------------------•------------------------------------------------------------•---------------------------------------------------------------------------------------- - 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)---- -----------------------------------------------/or. LL - -�--------------------------------------------------------------------------------Owner and/or Contractor) By:------------------------------------------------------------------------------------'-----------------------------------------------(Title)t-------------------------------------------------------------- (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 S- -------------------------------------------------- REVIEWED BY DATE- �----- ------------------------------------------- BUILDING PERMIT ISSUED---------------- - - - � t�----- ------- --- - -------- DATE-------------�------------------------------------------ Alterations _------------ - ------------------------- -_ te._r_ations n._d/or__re_co_ _m_m___e__n_d atio_ns_:--_�-_---1_yZ3 " --_.--.------ T / -- --- -------- - ............- - � ------ - --------fT --------- ------------- - --1--l-- - -h ^---------- � -- E ______________._______.________._______.__._______________� _____._-:-_.___________________w-------- _ ---- ______ - a -------------------------------------------- : F]NAL INSPECTION BY:. ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D 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 `f