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APPLICATION FOR SANITATION. PERMIT Permit No, A_/..!_'- F (Complete in Duplicate) ' 4 Date Issued _/��3- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work This application is made in compliance with County Ordinance No. 549. herein described. JOB ADDRESS AND LOCATION__ .z, ,5-_ &-� -- -V6'-�1�._. Owner's Name_. •--•----------------•-------- ---• --- --- Address------- ... ------ Phone---------------- •---•---------•-------•---------•--------------------•---------•-------•---•-----------------•---•------•---------••-- -- Contractor's Name...... J15-- Y - - -------------- --------------------•---•--- •-- - ---- Phone.--- Installation will serve: Residence K 'Apartment House ❑ Commercial F1 " Trailer Court El Motel(E] Other ❑ Number of living units: -------- Number of bedrooms ___I-__- Number of baths -'Lot size ---VS-01 .-r_ Water Supply: Public system ❑ Community system E] Private ❑ Depth to Wafer Table --- __-_,ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑` Clay Loam E] Clay F1 Adobe El Hardpan E]Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No'E] 'f TYPE OF INSTALLATION AND SPECIFICATIONS: rr (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well___-___:___ y -Distance from foundation-------------------Material_--------------,-------- -------•---------------- Disposal ----------- -- � ❑ No. of compartments--------------------------Size-----.------__ - I Liquid depth -- --------------Capacity--•----------- Disposal Field: Distance from nearest well-----------------Distance from foundation stance to nearest lot line___________-_____ r ❑ Number of lines__-___._______- ------ ----- Length of each line-----------------------------.Width of trench Type of filter material_________.-____ --------Depth of filter material-----------------------Total length---------------------------_______ _____ Seepage Pit: Distance to neareWwell -------------Distance from foundation--------------------Distance to a s# lot line Number of pits--------________ __.__ ------ -- Lining .Size: Diameter-_-- ---------Depth ------------ ---- +i Cesspool: Distance from nearest 'well______________ Distance from foundation_____-..__.________. Lining material------------------------------------- I, _._________.._._ ._ _- ❑ Size: Diameter---------)---------------- ----------Depth--- ----- L ------------------- Liquid Capacity- ------•-------------------gals. Privy-, Distance from nearest well____----------------- 4.......... ..____. Distance from nearest buildin c5 Q Distance to nearest lot line-------- - --------o -- --- -/ g------------- . ..�.�,..� ._----------- ff - �------ �----- - -- �. .�_.. •---•----•------------- Remodeling and/or repairing (describe):------------------ - ----- -----•--- - --------------- •---- ---•---------- ----------------- ------------------------------------------------------------------------------------------------ i ________________ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co unty ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-,------ -- (Owner and/or Contractor) (Title) ------ P of 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 _-_--_---._ REVIEWED BY----- ------•--------• DATE- ------.�/; ---- ----------------------- --------- BUILDING PERMIT ISSUED_ = DATE DATE_ Alterations and/or recommendations.......................... ---- • ---- ----------------------------------------- ---------------------- ------e_*,,-,4-.' ---------------------••----- ------------------- �� --Q...'-�� "- !,'c� Q 1 ---------------------------------- ------------- --------------------- -- --- ------------------- FINAL INSPECTION BY____________ i o - ate---------------------- 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 i