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- > yp APPLICATION FOR SANITATION PERMIT Permit No 10 (Complete in Duplicate) Date Issued 1�k � 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 compliance with �C��ounty Ordinance No. 549. oe— JOB ADDRESS AND LOCATION .l.tt�_C7.l.1___ 19 - -- ------- -- - ---------------- Owner's Name----- -- ----t--- -- -- -- -- -------- --------------------- ---------------__-_-------.------------------ Phone-------------------------------•---- Address------ 1C.. �//•� Contractor's Name._. __ ----- _______________ Phone!_;�; ' 'Qt Z I. Installation will serve: Residence U4-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms A,_ Number of baths __l___. Lot size ...6_'_0___,x.../__'ZS"'- '........... Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table „4�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe - ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [ ' o TYPE OF INSTALLATION AND SPECIFICATIONS: ( � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (/W� Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- %A �° _____________________-____________-______-_____-A�° No. of compartments--------------------------Size-----------------------•-------Liquid depth--------------------------Capacity--------•---------••--- t Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line________-_____ _ ' Number of lines-_--------------------------------Length of each line------------------------------Width of trench-.----------------.-__-__-_-_______ Type of filter material_________________________Depth of filter material---------------__------Total length__________________________-_--____________ Seepage Pit: Distance to nearest welhR, e<_,-__Distance from foundation__ 20.' __.__.Distance to nearest lot line----i�b....... Number of pits------/--------------Lining mate ria l__164-wc.a_----Size: Diameter__,3�-'-________Depth------- "__�_ ____________- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------________________________-___. ❑ Size: Diameter--------------------- ---------------Depth------------------------------ ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-_________________:___-____.__________- ❑ Distance to nearest lot line----------------------------------------------------------------------- I Remodeling and/or repairing (describe):___ _ ---------••--•------------•-----•------------------------------------------------------------------•---•----------------------------------•-------------------•-----------•----------•---------------------------•--------= ---------------•----------- -----------------------------------------------------------------------------•---------------------------------•---•------------------•-----------•----------•-------•-------••---------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. (Signed)......... -• --- - - --- ---------- f''L.-'-t'-� --"`'.G.'�- or Contractor) By:---- ( ) J •• rile - -- ------------------`-"'--...----------------- (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------------------- 'ru ;� REVIEWEDBY --_------- ----------------............. ---•---------------•------------------ BUILDINGPERMIT ISSUED...................................................................................................... DATE------........................... Alterationsand/or recommendations:............................................................................................................................................................... ----------------------------------------------------------------------------------------•----------------------------------------------------.....----•••-••--•--------•••-----------•-----•------•-•---•--•----•-•--•-----•- ----------------------------------------------------•-------•---------- -----------------------..........................................................................................................................---- -------------------------------------------------- ----•------------------------------------------------------•--•----------............................................................. ---------------------------------- --------------------------- ------------------•-•--------------------------------•--- ---- ------------------- -- - -- ------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY-------------U_.. �,G� ---------•---- Date--------l....-•-....-..-------------.....------------------------------•----- 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 'Revised W-2100