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APPLICATION FOR SANITATION PERMIT Permit No. 1413F__ ------ �; (Complete in Duplicate) Date Issued __��-{��e,D 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, ia �------4-Ap- t-� � ------------------------------- Owner's Name----------------•-------•---- --s-_"�------------------------ --------------- Phone._ Address------------ Contractor's Name--------------------------------------------------------- •------------------------------------------------------------------------------------ Phone---------------------------•----•-- mis ❑ ❑ Other ❑ Installation will serve: , Residence � Apartment House ❑ Commercial ❑ Trailer Court Motel Number of"living units: __ ____- Number of bedrooms __ > 9 l .�__ Number of baths __�_ Lot size ___ -------------------------- Water Supply. Public system ❑ Community system ❑ Private [R Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:_. Sand ❑ Gravel ❑ Sandy Loam E) Clay Loam ❑ Clay ❑ Adobe l] Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes X 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 well.-_��f-----Distance from founda;ion__j0._______Material__Cly-n-G✓' `� No. of compartments--------� -� --- 62_'x --Liquid depth------ �. - C -----"------- py. "_._. Disposal Field: Distance from nearest eft__. F i � -----Distance from foundat!on��O.f�r�_-pistapFe to nearest tot I;r�e�_-�•--�-+y� ® Number o?. lines-------•-,: .__-_-- Ir Length of each l ine_SD,,"�-Qa- _ fin h oftrench.-----FA ---`�----------------" Type of fitter material_r r , _ Depth of filter material__.-`! ------Total length---------2 � Seepage Pit: Distance to nearest well---,---------------- from foundation_-"-"----__ ----_.Distance to nearest lot line ❑, Number of pits----------------------Lining material-----------------------Size: Diameter-- --------------------.Depth------ ..Cesspool: __. a Distance from nearest well----------------- from foundation-----_-------------.Lining material-____._.._,_____.._.__ ❑ Size: Diameter-------------------------- ----------Depth----------------------------------------- -------Liquid Capacity-.----------- ---------------gals. Privy- 'Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line------------------------------------------- ------ i Remodeling and/or repairing (describe)_______________--___- -- ------------ --- ------------••-----•---------------------------------------------------------------------------------------------------- ---------------------------- --------------------------------------`----------------- �,-� I hereby certify that I have prepared this application and that the Work4ifl be one in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Si ned g )----•- --------------- ------------------------- = -------------------------------------------------------------------------------------------------- - - ----------------------(Owner and/or Contractor) plan. --ho ngsiz-------------------------------------- -- ------(Title)------------------------------------------------------------- 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FO DE MENT USE' LY APPLICATION ACCEPTED BY--_..._"- -. ' ---- _ = DATE---- - --- ---'� ----------------------- REVIEWED BY--------------------------------------------- --------------------- --- DATE 4 BUILDING PERMIT ISSUED------------- -------------------- -------------- ---------------------------•--------------------..__ DATE-------------------------- Alterations and/or recommendations___________________________ ----------I--------------------------------- ---------------------------------,f ------ ----------------•------ ----------------------------------------------------- - --- - -------------------------- FINAL INSPECTION BY:_ ---------f_.__--"-- / / — S ---- -- ------- - �' Date------- - ---------------------------- SAN --------------------------- 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