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G� (J APPLICATION FOR SANITATION PERMIT Permit No. _-zl (Complete in Duplicate) �j �ic Dete Issued 5'_1__f�.�.Appcion is thereby 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----------------�r�-- -- ------- �, �-------- ------- Owner's Name---------------- - •' r� -------------------------------------------------------- Phone- -- ?. ! Address-------------------------- Contractor's Name-------------------- - --- -----------------•--------------------------------------------------------- -------------- Phone----------------------------------- Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court F] Motel ❑ Other E]Number of living units: � Number of bedrooms ___YNCoumber of baths ---/-__ Lot size -------6-.0---XJ-3 -------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water.Table ________ ft. E Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet.). __Distance fra foundation________ _________ Septic Tank: Distance from nearest well_____ __ _____ --------------- Size _ _ Q Material --------------------------- No. of compartments----------- _ --- ---- uid de th______-__- Ca acit Disposal Field: Distance from nearest well------e[1 ' --.Distance from foundatio _____� Distance to nearest lot line`_ v____.. [� Number of lines------------�v______ . _____ Length of each line______ �______ -- �7_Width of trench----- ,--�- ---•---- Type of filter material__. --Depth of filter material-------- -----Total length_______ ____J�.._c�--r-_---- 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 wet!------------------Distance from foundation--------------------Lining material__________________________._______ ❑ Sze: Diameter--------------------------- ----------Depth--------------------------------------------------Liquid Capacity--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-.-.-----------------------_-_--____--__-- ❑ Distance to nearest lot line----------- --------- ---------------------------------------------------- ---------------------------------------------- • Remodeling and/or repairing.(describe)----- ------------------- - - k- ---------- - ------------------------------------------------------ --------------------,..----•-•----•--------------------------------------------------------------------------------------------------------------------------------------•----------_-------------------------•----------------------------------- ----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------- I hereby certify that I have prepared this application and that the work will be dove in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 5i ned `� ��.- , ( �g - - (Owner and/or Contractor) By ................---------------------------------------------------------------------------------------:------------------------(Title)--------------------------•----------------------------------- (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--- ? - -------------- : 9 - f REVIEWED BY------------------------------------------------- - ----- --- -------------------------------------------------------------- DATE-- - ----- -7- BUILDING PERMIT ISSUED------------- -•---- - -------------- ------------•-----•------------�--)------------ DATE- ----------------- --- --------------=----------------- A�lt//era}}tions and/or re ommendations:---�--y---- --�lCitf_ot ,nr '_4/t2A�! ilprt _�llP_ � '�_d3_ p - -�Yl� W, -//fa f 1 - - i�r-------- - ---------- - - - - - ------------------------------------------------------ - ----------------- ---------------------------------------------------- f - -------------------------- ---------------------•-------- FINAL INSPECTION BY:------- r-- ------------------------------ Date 4 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 E5-9-2M 8-51 Revised W-2100