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\ APPLICATION FOR SANITATION PERMIT Permit No. 07 I (Complete in Duplicate) -Date Issued __40.-_.. Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549: JOB ADDRESS.A LOCATI N... •-••- ! -------------- -C --- -------------- ... ----------- Owner's -Owner's Name--- •- --- -- -- ----- --- ---•- ------ ------ ------U--- - - - ------- -- -- ---- Phone_-ca: 96 /------ Address----.--51...--- ---------- ------------ -----------------I------ -------------------------•-- ............ ---=----------------------------------------------- Contractor's ----- •----Contractor's Name•--- --------•-• -•- •--- --------- ----------------------------------------------------------•--- -------- ---------- Phone----•-- -• ----- ------- Installation will serve: ResidenceApartment House E] Commercial F1Trailer Court 171f Motr1 ❑ OthF ❑` Number of living units: __L_L_ umber of bedrooms ___X_ Number of baths __1---7 Lot size --- a --__ x -6` --------------------- Water Supply: Public system Lommunity system ❑ Private ❑ Depth to Water Table ______ ft. Character of soil to a depth of 3 feet: Sand E]Gravel Sandy Loam Clay Loam Clay E] Adobe❑ Hardpan Previous Application Made: Yes ❑ No New Construction: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ ' ( P // nn ! Septic ank: Distance from nearest well -- _Distanc f`om pnda r____--t__1/ Mater' 1 � t - ---- No. of compartments______ ___ ______--Size.- Liquid depth--____---�--------- Capacity-____C :� Dispos Field: Distance from nearest well ""___--__.Distance from foundation...�__Q_ -_-__Distance.to nearest lot line Number.of lines___ ___<_j____ •Length of each line-----L�_Q____*_------Width of trench............ � _------------- Typo _ ___- Typo of filter maters _ p _Depth of filter material__ 1{� Total length------- 7u_____ Seepage Pit: Distance to nearest well--------------------.-Distance from foundation____:- _________•..Distance to nearest lot line........... .__ �\ ❑ Number of pits___________________Lining material-----------------------Size: Diameter----------- -____-___Depth-------_-------------------- Cesspool: __ -____-____-__Cesspool: Distance from nearest well-----------------Distance from foundation------------._____.Lining material-_. ______.-:____ ____......... RSize: Diameter---- ------• -_----Depth---------------------------------------------------Liquid Capacity------ - ------------gals. Privy: Distance from nearest,well-------------------------------------------------Distance from,neari4 building_______ ______ ___ __ _____________ ❑ Distance to nearest lot line----------- ---- ----------- --- _------------------------------------------------ - ---- ---------- L Remodeling and/orrepairing (describe):............... ----------------------------------------------------- ..................--------------I... ---- ......... •----• ------------------------------------------------------- -------------------------- - --------------- -- ---------- ---•--`------- ----•----- --- -- ---------- -_-------------------- 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 rul4p and' regulations of the San Joaquin Local Health District. ------ - ------ --- ----- - (Owner and/or Contrac#or)(Si ned)- BY ------------------------------------------------ ----- -•----- ------ ------ ----- -- ----- --------(Title)------------ --------- ---------- --- �•. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMT USE ONLY APPLICATION ACCEPTED BY... -- ------- ---- ---------- - -------- -------- --- - --_ DATE- j;,,• - REVIEWED BY_ --------- -- DATE BUILDING PERMIT ISSUED--- --- -----------------I----- *_____,._,_,___,.,0.__A J- DATE----------- - Alterations and/or recommendations:---------a---h---` �� ---- - ----------- -- FINAL INSPECTION BY:...... "`'' �14--------------------------------- Date-----� � � ��--------------------------------------- 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