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N / y � APPLICATION FOR SANITATION PERMIT Permit o:� 74, (Complete in Duplicate) =" Date Issued 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 Counfy'Ordinance No. 549. JOB ADDRESS AND LOCATION.... ---------- Owner's Name----�. _ z_:-- r's_�r =. - - _.._ Phone 1 = �..� Address.---- '' --. . ----------------------------•-----------•------------------".._...--------------------------------- ----------- f,--nn, - Confractors Name------ : . _=i f,--n,tet-• ------------------------------------------------------------------ Phone__ ----------------------------•- Installation will serve: Residence [4 Apartment-House 0 Commercial. [] • Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms _-._.Number of baths ._11 Lot size _.�+�__2__X_L9:?�-------------------------------- Water Supply: Public system'N' ICCommunify system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3.feet: Sand ❑ Gravel ❑ Sandy Loam E] Clayt Loam ❑ Clay E] Adobe Hardpan ❑ Previous Application Made:.Yes E]. No.,Z New Construction: Yes Z No El 'l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank or cesspool permitted if public sewer is�-available within 200 feet.) Septic Tank:w Distance from nearest well_________________Distance from foundation-----_--------------Material"--_--__--------______..____________...._____.._. []._ ► No, of compartments"- -- ------Size--k------------------------=---Liquid depth--------------------------Capacity Disposal Field: Distance from nearest- well------------------ from foundation___________._-__"--.Distance to nearest lot line_______-________ ❑ ,,,,j Number of lines-------------------------------- Length of each line--:---------------------------Width of french----------------------------------- S Type of filter material-------------------------Depth of filter material----------- Total length-------------------------------------- 4 Seepage Pit: ti, ;Distance to nearest well___4144-----------Distance from foundation?=_.. .---------Distance to nearest lot liner:-�:_____-._. N f f `Number of pits------ _ Linin mafienal-- --------. _.Size: Diameter---- ------------ --Depth_-- ---------------____-- iJi Cesspool: _ Distance from nearest well------------------Distance from foundation-------------- material-------__"_ -_____________.__.______- ,l ❑ Size:'Diameter'- "` .-- Depth_'--------=------------=---- Liquid Capacity gals. Privy: Distance from nearest well ____________------_----------------------------Distance from nearest building____________________________.____-_-__. ❑ Distance to nearest lot line---------=---------------------------------- t--- -------------------------------- -------- -------- s Remodeling and/or repairing (describe): le:- _ ___ _�ti ------------ - � cc ' f _ _------ ------ ( t ------- -------------------------- --------------•---------------- ------------------------------; . 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. -______---�.C__'�_"•- _____--____ (Signed) (Owner and/or Contractor) !'_ -- (Title)---- --------------------------------------------------------- By ± (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------------- -----• J l ---- ---- ......... REVIEWEDBY-------------------------- --------------------------- ----=----------- ------------------------------------------ DATE---------------------------------------------- --------- BUILDING PERM•IT'ISSUED-" - i _ ---- --------------------= DATE------------------------- -- Alterations'and/or recommendations:--------- ------------------• -----------------------------------------------------------------------------------------------------------------._......"----- ------------------------------------------------------- •-- -------------------- r •--•-•---------------------------•-•----------•----•---•------------------------------------------------------------------- ----------------------- ----------------------------------------I----"---------- ---------------- 7 FINAL INSPECTION -BY---------------- --- =------------- ------ Date.-------- 4 --------- 1 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 ES-9-2M 10-52 Revised W-2100 }