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APPLICATION FOR SANITATION PERMIT Permit No.93_3 + (Complete in Duplicate) *` w a Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to cctruct and install the work herei desc bed. This application is made incompliance with County Ordinance No. 549. 01'JOB ADDRESS AND LOCATION-_ Q T- �?�f-+E� �" ° a`'' j 4--'1�--- Qe Owner's Name---- -•_J:_-`"'"t...••. ¢�� - Phone --- f; —1 -- - c r..0_17 Address 3 J-• (�Lr!: =-'L= �- l-1 ' . ----- ------------------------_- -- -------- -----_- Contractor's Name................................... --------------------------------------------------------------- Phone................................ Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ s Number of living units: _-_ Number of bedrooms __Z. Number of baths __/__ Lot size /_3_/�_____ ................ Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table ________ ft. a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E[ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Mader Yes ❑ No X New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ;W" r Septic Tank: Distance from nearest well___ .emit....Distance fromyfoundation___�Q______.____.Mater�al_�_ e� _---- ----------- No. of compartments__-_____ ________Size___7-�_6_-',�_-�__Liquid depth------ �---_-___-_Capacity__,_-i�_ _40___- Disposal Field: Distance from nearest well------------------Distance from foundation__-__21-p Distance to nearest lot liner-- --------__ . 21 Number of lines. -----�----- ___ Length of each line_______ Width of trench ............. Type of filter material____)&_ _____Depth of filter material_-____-/Y*'______Total length______--------- ________________ t � Seepage Pit: Distance to nearest well--/FQ----------Distance �jro� mrfo dation___--_________.Distance to nearest to line_ Number of pits--- --- Lining material__Al� -Size: Diameter---�2_ -------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 repairteig (describe)------ I----------------------------------- ----------------_----_-- _--------------------•- -----•-- --- -------- ------- ----- ---------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with. San Joaquin County ordinances, St a laws, and rules and regulations of the San Joaquin Local Health District. (Si nedd 9 � - ------------- -------- ------------------ -- --------- --------- --------- -------- --------- _-(Owner and/or Contractoc�El --------------------•---------------------------------------- ----------(Title]-- ---------------------------------------------- --- ------------------------------------ ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT US ONLY APPLICATION ACCEPTED BY :t --------- -- ---------- DATE------- _ . fit""--------------- REVIEWEDBY------------------------------------- --------------------------- ---------------------------------------=---------------- DATE- --------------------------------------------- - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------ ---------- DATE•------------------------)- ------- - - ......... Alter 'ons and or, recommendation : _______________________ __ _ -_--- ---- -• - ' .� IS--- -- ----- -- FINAL INSPECTION BY:_-_.... 4---- -------- .................... Date----- h�- ---------------- - 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 8-51 Revised W-2100