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/^ v � No.�-s��•-"�--1------- APPLICATION FOR SANITATION PERMIT Permit xi li D i l (Compete n Duplicate) i Date Issued x}� 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 Ordinances No. 549, JOB ADDRESS AND L CATION___/&-j;�1-------- �---- f ------------------------------------------------------------ Phone Owner's Name-------- ------•---------------- -------------- --------------- --------------- ---------- ` ------•------------------------------------------------ •---------------------------- Address------------------- Phone------ ------- Contractor's --------- Address------------------ Contractor's Name --------------------------------------------------------' % ' Motel one Other i Installation will serve: Residence I Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ ❑ Number of living units: Number of bedrooms I____ Number of baths ---/-. Lot size -------- /._39___*-----------F-------- � 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 N Hardpan ❑ Previous Application Made: Yes ❑ FNo PK New Construction: Yes ❑ No , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if'public sewer is available with' 200 feet.) I Septic Tank: Distance from nearest well __-.Distance from foundaticn___3' -_--.----.Materiae------ ------ - Q� Ef No. of compartments---------;------- Size Liquid?� S`x Liquid dep�th� 4e------------Capacity-/.5.�&_D...... (� �/ .]---. .Distance-to nearest lot line----ZS___--. Disposal Field: Distance from nearest well_,-------.Distance from foundation-'7 Number of lines-------------/.�------------- ---Length of each line---:------------7_57-----Width oftrench-__-_-rZy�_---------------- Type of filter materiaf_�11.=1�r�DC- -Depth of filter material -e-`__'_._=----Total length---------- - -----__-_____-._.----- Seepage Pit: Distance to nearest well----------------_---_Distance from foundation----.---------------Distance to nearest lot line_-_--_-----._---. ❑ Number of pits---k------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------= Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------- _.. ❑ Size: Diameter---'--------------------------------Depth----------------------------------------------------Liquid Capacity-------- =--------------gals. I Privy: Distance from nearest well------------------_-_---------------------------Distance from nearest building-___-------------------------------------------- - T " ❑ Distance to near --est lot 4ine____- ------------------ ------------------------------------------ Remodeling and/or repairing (descri...be):_ -__T --__-__IV -------- ---------- �-- •--------------- ------- -.1-1 --•-------------- ,. •• ------------ ------.----- ----------------------------------!-----------•----- -I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, an rules an r gulations of the $an Joaquin Local Health district. (Signed)_ ----------------------- (Owner and/or Contractor) . -- ----------------------------------- -------------•----- -- f By:---------------------------------------- -=-----------•------------------------------------------------------------ -(Title) (Plot plan, showing sire of lot, location of system in relation to wells, buildings,'etc., can be placed on reverse side). r ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- --- --- --- -- -- DATE------Q'-- -- --- -- - --------- IV ---- DATE REVIEWEDBY----------------------------------------- ------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------- ------- DATE = Alterations and/or recommendations------------------- --------------------------------------------------•----------------- ---------------------- Q -- - ------------------ -- ---i Y ----------- , -------------------------------- -------------- "-------------------- . ........... --- ----- ---- i ______ __ _____________ __ __ ----------- iFINAL INSPE Q Date---------- --------------------------------------------------------------- i SA JOAQU N■L'OCAL HEALTH DISTRICT ' 814 North "C" Street 130 South merican St t 300-We sf Oak Street 132 Sycamore Street F Stockton, Clif �ia.e...�••-�'"'"�" " !i � Lodi, California Manteca, California Tracy, California eor ES-9-2M B-51 Revised W-2100