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APPLICATION 1=0R, SANITATION PERMIT Permit No. I__z ___.. ` ` n` •y in Duplicate) " ,� �� _'a' •r� (Complete P } Date Issued�4_./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'�wi h County Ord' rice ND. 549. JOB ADDRESS AW LOCATION--1, __,___------- ---- I1:L Owner's Name---- ------------------------ G _----------------------------------------- Phone---Z=-�--------------------- Address--------------------- - --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name-- --------- ------------ � - ------------------- Phone---------------------------------- Installation will serve: Resil'ldence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other T Number of living units: ___---- Number of bedrooms _/.NumVDepth baths ___1-__ Lot size ___ __J___ !----------------------------- ` Water Supply: Public system El Community system ❑ Private to Water Table ________ ft. ' Character of soil to a depth of 3 feet: Sand � Gravel F1 Sandy Loam C] Clay Loam ❑ Clay [-] Adobe �ardpan El Previous Application Made: Yes E] No VNew Construction: Yes 19/No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feel Septic Tank: Distance from nearest well C570 __Distance fro foun ion__=�� ------Mat rtal___________________ ___ �l Size___ Li uid de t No. of compartments / x a p -------�- --- --------Capacity----�1 Disposal Field: Distance from nearest well__c519_____Distance from foundation___'----------Distance to nearest lot line-_____ [ Number of lines Length of each line------------------ r _---.Width of trench______ Type of filter material___________�__________ epth of filter material_.------I-9---------Total length______- '_ ------•----------- Seepage Pit: Distance to nearest.well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter--------.---------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______-____-____-______________-_____,- - --. - 0_..�.= -�S-i=ze-':.^D.._.,�a-me^ter--------------------------------------Depth - ------.---^--------_,-r-r-------,I,.---- --s'-�-Liquid Capacity C_lt_=y - - ----.:`---aw.,..---r-te- ----gals. Privy: Distance from nearest well__________ -----------------------------_______Distance �rom nearest building-------. -----------------.----------------_' ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------ •----•------------- Remodeling and/or repairing describe :----------- -=-- ----- - ---------- -- ----J- ' ------- - --- = ::: -------------------- ----- - ---- - ------------- .. ... = �._ A. -.: ----------------------------------------------------------- ---------------------- -------------------------- - ------------------------------------------- -------------------------------------------------------------------------------------------- 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- ------------------------------- -------------------------Owner and/or Contractor) Tale (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--- -� --- -- -------- ------ -- ------- REVIEWEDBY----------------------------------- ------------------------- ----------------------------------- DATE ----� .------ ---------------------- BUTLDING PERMIT ISSUED------------------------------------ / DATE Alterations or recommend tions:------ ! ---- ---------------------------------- ------------ . -------------- �------- FINAL INSPECTION BY---------- -- ---------- ---------- =":-------•------- Date-------•-� -.�- -------- ---------FINAL 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 A r