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5 , l Permit APPLICATION FOR SANITATION PEB�MIT� �...3 tThis (Complete in Duplicate) Date Issuedpplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION-------.�?Z-7r Owner's Name-----------•-------•------------------ > Address a ..__ a ---------------------------------------------- } Contractor's Name--------------------------- _ -a_ -- _ 1_ -' --` =��k �--- •�--------•-- Phone-- jet Q Installation will serve: Residence Apartment House ❑ Comme'cial ❑ Trailer Court ❑ Motel ❑ Other ❑ _ Number of living units: _K Number of bedrooms 3---- Nunmber of baths _"1!" Lot size _____ _ _ - ________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ft. P Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ a� Previous Application Made: Yes ❑ No % New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Eef is Tank: Distance from nearest well________________Distance from foundation---------------------Material------------- ___________________------_________- ' ,^• No. of compartments--------------------------Size- ------------------------------Liquid depth---------- -------------- Capacity----------------------- _Pisprusal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest-'Iof line__._-_________-- . , -----------------Length of each line------------------------------Width of trench---------------- ' �'E..�-- Number of lines------------------ ----------------- T p e of filter material_______________________ e th of fi ter afer'al------------------------Total length------------------------------------------Type , p"- -Seepage-Pi#: Distance to-nearest.w,ell _________---Distance fr m four ation_ __._____.Distance to nearest lot Number of pits___-I---------------Lining materialSize: Diatimeter' De th Cesspool: Distance from nearest well-----------------Distance from foundation_---_------------------------- material------'__:_:______________________--- ❑ Size: Diameter--------------------------------------Depth------------------------`---------------------------Liquid Capacity-=--------------------------gals. Privy: Distance from nearest well---------------------------------------------___Distance from nearest building________--._----_______________________- ❑ Distance to nearest lot line-------- ---------------------------------------•------------------------------------------------------------•----------------•---------------- Remodeling and/or repairing (describe):---___-_--- -- -------------- ---- -- - - - ------ -- ---- = _ ------- --- ' -------------------------------------------pes -------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify thatared this a plication and hat the work will be-done in accordance with San Joaquin Coun ordinan ec`s,_51cot laws, regulation of the an Joa uin Local Health District. (Signed)-- � "' ----�-- � � --------- - '-—" :---------- .( � Contractor) Y:------- =_ -- -- - -----------------------------------------------(Title) �� /�----------------- (Plot plan, sho g size of lot, locat�. ,em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE-ONLY APPLICATION ACCEPTED BY------- '---------- ------------------------------------------------ DATE----=------ REVIEWEDBY-------------- -----------------------------------------------------------------------------------= ' - - ' DATE n = BUILDING PERMIT ISSUED = ---- DATE---- --==-- y. Alterations and/or recommendations---------------- - ------ ---- ,_ -- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------•-------------------------------- --------------------------------------------------------------------------------------- --------=-- ----------------------------------- --------------------- I - --------------------------------- ------------------------------------------------------------------- ---------------------------------------- 4 FINAL INSPECTION BY: Dose - ------ ------------------------ 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-9-21A 8-51 Revised W-2100