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APPLICATION FOR SANITATION PERMIT Permit moo-- �j (Complete in Duplicate) G_ Date Issued ---,Orzx�^` -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 Ordinance No. 549. JOB ADDRESS AND LOCAT ON_.__ . r x'Y7 il . Owner's Name.... _ - - --- e.!-- -- -- ----- ------ Phone-- Address---------- _ Contractor's Name-., r?- ••--_- ---------------------------------------------- ----- ------------ Phone-- Installation will serve: Residence Z Apartment House ❑ Commercial El Trailer Court E] Motel [j Other ❑ Number of living units: _.j_-_ Number of bedrooms -.�-- Number of baths _J-_•_ Lot size _`47-40__ -`_ ..4' 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❑ Previous Application Made: Yes ❑ No W New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------? Distance from foundation___/��•_r_-_-.Material_--� No. of compartments p Size_' ' Liquid depth *1 Ca aci Dis oral Field: Distance from nearest well. �_--_---_--_Distance from foundation- �_,-----.Distance to nearest lot line•_-.�_--____. Number or lines----------1_--_----- -----------Length of each line_-_--_1_�►- / ` Z Width of trench. -----------•---- Type of filter material__.1;t ,f Y _Depth of filter material_-ZAL-----------Total length...l_,,Z7---------------------------- 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 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 la and rules an�re 'ons the San Joaquin Local Health District. � r (Signed)---- --------- - ------- ----------------------------------------------------------------------------------(Owner and/or Contractor) By:.................. -------- Tale ----------------------------------- (Title) (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - - -- - - --------------------------- --•---------------- DATE----,P-'_/�-.C`-3------------ REVIEWED BY--------------------------------------------- ------------------------------- DATE -------------------- --------------------------••-----•-----•------ BUILDING PERMIT ISSUED--------------- Alt a+ions nor re ----- d / endati ns:• j— I ------ .............• -------------- ------------------------------------------- j --- •-•--- ,-.,:.-. :tom$,- �, �, .- . = FINAL NSPECTION BY:-_ ✓ r---------------------•------ Date-------- $>0 S3 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 10-52 Revised W-2100