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., r o APPLICATION -FOR SANITATION PERMIT Permit No -___ . A{Complete in Duplicate) j Date Issued _ ___ Applica+ion 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 complian e with County Ordinance No. 549. l /1 JOB ADDRESS A D L ATIO �a d----- �J Owner's Name_-_.---_ ------ --------------------------- Phone --- .r Address7--------------------------------------------------------------- -------------------------••------ 1 . Contractor's Name------- ------- _.............. --------- ---------------------------------------------------------------------------------------------- Phone ----------------------------------- I - -.nom I.. , _ . �-.._..,— .�....- � _n_ .._ Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ 1 o1; el ❑ Otthej ❑ Number of living units: __'___ Number of bedrooms �_- Number 3j/baths __f-.___ Lot size_��_��-��/------------------ _________ 3 Water Supply: Public .system ❑ Community system ❑ PrivateWater Table -------- ff- I Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy a C y Loam ❑ Clay El Adobe ❑ Hardpan E]Previous Application Made: Yes ❑ No New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: 4i `{No septic tank or cesspool permitted if public sew r is available within 200 feet.) pR j - F Septic Tank: Distance from nearest wel1��.______ � Distance fr, rF fordation________________ Mater alr - No. of compartments--`-z-1......I5. x X------Liquid.diePth- -- N Dispo Field: Distance fromnearest we19! �D'istance from fo�ndation_�_fJ-'__.-Distance to nearest lot lie ' ._ ------ ,�. • Number of -lines -------- A____ ____ _Length of each line____________ Width of trench___.___ ____ L �r rType,of,filter materi_-'L`-�Uepth of filter material_--_1�__._______Total length -------- ___________________ :t.. 4: 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,fror foundat.ion_.y---------------- Lining. material_______ :-----___.____________ (�} ❑ Size: Diameter_: =-------- ------Depth---------------------•-•---------------------------- Liquid Capacity --------- ------------------gals. r_ + f OPrivy: Distance from .nearest well ----------------------------- .------------------- Distance from nearest building ----------------- ____________--_--_____._. ❑ Distance to nearest lotJine--------- _------------------------------------------------ Remodelingand/or repairing (describe)---------- ------------------------- ------•--------------------•---------••-•-------------------•-------------------•---•------------------•-•----------- --•-------------------------•-----------•----------------------•-----•-----------------------------------------------------•-----------------------------•--------------- -•----------------------•------------------------ -----------------------------------------•--------------------------•--.....----------------...--------..------------------------- 0i ---------------------------------------------------- ---- ----•-------------------•--------....------------------------------•---•---------------------------...-------•----------------------- 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. ----------------------------[Owner and/or Contiactorj By=------ L t =`---------------------(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 s APPLICATIONACCEPTED BY__----------_------------------------------------------------------------------------------ DATE=-------------------------------------------------------— REVIEWEDBY------------------------- -------------------------- -------------- DATE--- ----------------------------------- -------------- BUILDBUILDING DATE_._:. - ING PERMIT ISSUED----•°---------------------------------------------------------------------------------�M-.:$------------------------------------------------•-------- Alterations and/or recommendations:----------------------------------------------------------- ..---------------------------- ----•-------- • . •--•--•---...---••--••------------- - -- - ----------- --- -- ► _ .� ---------••----------------•-•----------•---- ------ --- -------------- _C:15_ --_------ - � _- � ----------------------------------- --------------------------- --- -..---------------•-----------•-----••----------------------------------------------- Date... FINAL INSPECTION BY------------------------------ 130 South American Street Stockton, California ES -9-2M ; Revised W-2100 SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street Lodi, California Manteca, California 814 North "C" Street Tracy, California