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t 1 y APPLICATION FOR SANITATION PERMIT Permit No.-7___.7-_?Y_dd_.... {Complete in Duplicate} Date Issued ' Application is'hereby made-to the an Joaquin Local Health District for a permit to construct and install the work herein described. Tf' This application is made jd.compliamll`l'iitCi,&nty O;j 5/49. /V� JOB ADDRESS 'A' Q LOG TION_.. �� m ------------------ ------n-- ------------------------------ ------------------ Phone- __'�__ -- -�-��---- Owner's Name---' ----------- �---•------------•--------------------�------=- ----�r-,_�- f� � " Address.-- -`77 -------------------------- ---- --�..�i�`-' --------------------------------------------------------------------------------------------------- Contractor's Neime__ ---------------------------------------------------------------------------------------- Phone----------------------------------- Instaliation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ �I ❑ Other ❑ g � ' ' E - Number of living units: __1.4t__ umber of bedrooms _het-_ Number of baths _ __ Lot size ---_ _____ __ ------------------"-"-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand)Z Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe /Mardpan ❑ Previous Application Made: Yes ❑ No R"' New Construction: Yes eNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)/.) d U " Gf Septic anh: Distance from nearest well___=_________Distanc from found tion___-�S/_________°Materiaal�_" ___`__ � .4 No. of compartments------------- Size_-. __ _ _Liquid depth----------5 Capacity___- s __Q_- Disposal Field: Distance from nearest wel ________ _____"._.Distance from foundation"-�_ _____ _Distance to nearest lot line _� Number of lines____________ __ _____"_ _,Length of each line _?tQ_`_____ r Width of trench________ ___ -�� Type of filter material ;,� p - Depth of filter material-------_�-- -___----Total length----_-_--I _A ____" Seepage Pit: Distance to nearest well___------------------Distance from foundation--------------------Distance to nearest lot line________-__:-____ !` ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h-------.------------------------- k ' Cesspool: Distance from nearest well-______"______:__Distance from foundation_________"___"___-.Lining material________________ _________________ t ❑ Size: Diameter--------------------------------------Depth_.---------------------------------------------------Liquid Capacity ---gals. Privy. Distance from nearest well--------------------------------------------------Distance from nearest building_____________________________________ ' ❑ � ------ -- Distance to nearest Irne___ a --------• ---- _--Y --;- ----••- ------- _ Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------•----------••---------------------- ----------------- -------------------------------------------------------------------------------------------------------------------------•-------------•------------------------------------------------------------------------------- ------------------------------------------- --------------------------------------------------------------------------------------------- --•-------------------------------------------------------------------------------- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to ws,`and ules and regulations of the S n Joaquin L I Health District. (Signed) 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-�`' ------ -------------------------------------- REVIEWED BY----------------------------- _� DATE ------------------------------------- ------------ BUILDING PERMIT ISSUED------------- ----------------------------------- --- DATE------ �� Alterationsand/or recommendations------------------------ ------------------------------------------------------------------------------- �------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------•-------------------------------------------------------------------------------•------------------ --------------------------------------------------- ------------------------------------------ -- ---------------------------------------------- - ----------- -------------- ------------ FINAL ---------- FINAL INSPECTION BY------ - -------f5.. `____ _:_":' Da ------------ - 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 � tt ES-9-2M 8-51 Revised W-2100