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, 3 APPLICATION FOR SANITATION PERMIT Permit No. 0 (Complete in Duplicate) Date Issued _ _�/5, '3 App rca ion is hereby made to the San Joaquin Local Healfi This application i h District fora permit pp on is made in compliance with County Ordinance No. 549, p mrt to construct end instal! the work herein described. JOB ADDRESS AND LOCATION_.__412, 1 " ,J-- - Owner's Name------. ---------------------------- •---------- Address ------------ --------------- Phone---- - ----•------ � --------------------------------------�•-- ---- ----------------- m Contractor's Ne__. _ --------- ------ Phone_-- Cf Installation will serve: Residence p = - g------ 1 �+ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: _1___ Number of bedrooms _ ❑ Other ❑ .�_ Number of baths ._ ._.__ Lot size _____ _ ' Wafer Supply. Public system Communit system t �� ' "" ------------ Y Y ❑ Private ❑ Depth to Water Table _�4ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam F] - Clay Loam❑ Clay ❑ Adobe H Previous Application Made: Yes No � ardpan ❑ ❑ A—New Construction: Yes ❑ No ga--' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic C Taw_ Distance from nearest well___-__"-___-.._._Distance from foundation--------------------- ___-___ - "�`�'/a�' No. of compartments------------- - - ----- ---.Material---- -------�------ ---'- --------'---- -------- ----------Size---------------------- ---------Liquid depth--------- ------ --------Ca.pacitY ----------- I Disposal Field: Distance from-nearest well-------------- --------- d -.-Distance from foundation--------------------Distance to nearest lot line.________._____- I ' - Number of lines---'------------------------ -----Length of each line---------'------------_--- ._.Width Type of filter material------------------------ Width of french--_-_____.___ --- ----'-.'Depth of filter material--------'--------- ----Total length Pit: Distance to nearest well_ - K,_Distance from foundation__ --_ g s V� Number of pi}s____. �D � ._.__.D;stance to nearest lot Irne___ --.._--__-Lining material_G�cl( ( Size: Diameter__ Depth r Cess ool: - ❑p Distance from nearest well-----------------Distance from foundation--------------------Lining Size: Diameter------ ----- - , Depth --- --- - ------ -------Liquid Capacity------------------- . � . . ,. _ - ------ -gals. Privy: Distance from nearest well_______------- ____ _______ " -----._.____-.___-__Distance from nearest building................" "__ ❑ Distance to nearest lot line____._ ___ ...... Remodeling and/or repairing (describe):-- -- _ _ ----------------- I hereby certify that I have prepared this application and fhat the work will be done -- accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)- - � � ' -' -----kA - ' a��V - ----'-=`--'- -------- --- ---- -- -'- -'-'----( =-arid�ar Contractor) ----------------------------•------------------------------------ (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., canbe placed reye she side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- - ------------------------------------------•--------•----------- DATE REVIEWED BY ----------------- -------- - - ----'-------------- ------- --- - -'------- - ------ ------- --------- DATE------ ---------------------- 1 DING PERMIT ISSUED-------•------•-------•--------------------------------------- ------_- - -----" - ------------------------------------------------------------------- DATE..---------------------------- ---.................... ---- - A terafions and/or recommendations: _____________________ --------------------------------------------------------------------------------------------------------------------------- ------- •------------ ------ •--•------•- -------- - - ' -- ---------------------I------- FINAL INSPECTION BY----------------- •---'------------ Date---------- ------- .... ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak S+reef Stockton, California i32 Sycamore Street 814 North "C" Sfreef Lodi, California Manteca, California Tracy, California ES--9-2M 10-52 Revised W-2100