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Al APPLICATION FOR SANITATION PERMIT Permit No.,?-,O / �? b (Complete in Duplicate) �.�`' Date Issued/�. 3 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 County nanc N 549: JOB ADDRESS AN LOCATION Owner's Name------ -----✓ �'"� x --- --- -------- Phone-- �� ---------------- Address. ----------Address. I r_ _ ,---- ..................,.----------- Contractor's Name..- ------ -- - - -------------------- -- ----- - ---------------------- .------ Phone- ----- _ -------I-- ----•-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ,Motu! ❑� �Other Number of living units: -------- umber of bedrooms _24_ Number of baths ...I__-;Lot size -- ______________ ---------------- T-3 ..,.__ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --- __ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑ Adobe Hardpan E]Previous Application Made:' Yes ❑ No New Construction: Yes Yr ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public swer is available within 200 feet. # Q Septic nk: Distance from nearest wellk _...Dista a frofoun tion Mate/,r�I _ ___---------------- No. of compartments__________ ___ _ Size-Z-- .�`Liquid depth___-..-_-.-1- ________Capacity-_ I ��}} Dispos Field: Distance from nearest well ,/. __Y --.Distance from foundation 12t -_.•Distance to nearest t I q Number of lines_-. ._______ Length of each line.__.__.� 0�_ -1r-Width of trench . �____♦_--_---.-- Type of filter material_ epth of filter material Total length 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 from foundation-------------------Lining material-----------------------------•....... ❑ Size: Diameter----- --------------------------Depth...... ..._--- - Liquid Cap amity Privy: Distance from nearest well.......... ------------------- ______Distance.from nearest building---------.................. ❑ Distance;to nearest lot line------- ---------------------------- . ----„........-- ------- ---•- ------ Remodeling and/or repairing (describe)•--.......... ---------•------- ------------------------------------------•-- -- --- --•---- -................................. ----------------------------------------------------------------- -.---•----- -- ------ .............-------------------------I.......... • ••---- -------•-------- --.................. ------- - ------ -------- ------ ------ ------- ---- --- ------- ------- -.---- -------- -------- --- 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. (Signed).-. .............. ------- -------- -------------- ------(mer and/or Contractor) l� . ---------(rifle). -------- --------• ---- --------- ----------------------- - --------- (Plot plan, showing site 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- 1� - -------- ---•--_------- I----------- REVIEWED BY ---- -•.--------------------- -- ----- -------- DATE------ -- - ---- .------ • ------- BUILDING PERMIT ISSUED ............ - - ,D TE Alteration d/or rec rgmend wns �s� `# ( i - - -�`? -------------------------------------------------...................------------------------ FINAL INSPECTION BY:....... ............................. Date........ .. "'----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 811 North "C" Street Stockton; California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100