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vpp\l ATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 1 Date If i� I ssuedApp is tion ishereby maa to t e San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County dinance No. 549 JOB ADDRESS LOCATIO c _ _ _ •___.- Akl_-- _ Owner's Name..... ............. . -•. •---•-• . . -- ----------------- ------ Phone------ --- . ... ....... .. . Address.- . .. . .. ................... Contractor's Name.:-. __ ------- - ---- --- -------------------------------------------------------------------------------------- -------------- Phone---------------------- Installation will serve: Residence Apartment House ❑ Commercial F] Trailer Court F] Mnotpl ❑ Othet ❑ Number of living units: -_I-__ umber of bedrooms J___ Number of baths ---/--- Lot size V x►-� 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 M ardpan ❑ Previous Application Made: Yes El No [ New Construction: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted i ublic sewer is available within 200 feet.) Septic ank: Distance from nearest well___ istance, fro ound ion__�_0aI i No. of compartments______ __ - e - ► X+ Liquid 0eI?th--- -- --- - :-Ca acit p Y Dispo Field: Distance from nearest w I _ stance from foundation j istance to nearest lot I' a �7 Number of lines___--___.-_ --- �_ �r- �Length of each line___.___.. �_? Width of trench_._ Type of filter materi -��k�G�k7epth of filter material---------�-�-�----Total length---_-�?,� ---------------------------- Seepage Pit: Distance to nearest well-----------__________Distance from foundation_--.__._.__.___.__..Distance to nearest lot line....._.-.._ x ❑ Number of pits----------- ------Lining material---------- ------------Size: Diameter---------- ------------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 Remodeling and/or repairing (describe)__________________ ---------------------------------------- ---------------------------------------•--------------------------------------- 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 rul s and regulations of the San Joaquin Local Health District. (Signed)--- . - - ------------------------------------•-----------------------------------•---------------------------------------------(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-------=----- •-------------------------------------------------- -•.............•---•...-••---•---••----•----- ----------------------- D Alterations and/or recommendations:_._________.__.._ __ A ................................................" - ., E - /� �� --------- e �� ) �n" ------ 6 y s •� +i°'�`' r� ------ . ir t .- ------ - --- he. .. - " d INAL INSPECTION BY:.____ f___•_ � ---- - ------------- - Date----- a- / /�.`��d�G✓ 4 t c.,^"�l.�t`-"� +ems`{ � `w yo ' _L._ R•Y �y�------------------ ` ""USAN JO QUIN CALH ALTH S RICT ' 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