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t - APPLICATION FOR SANITATION PERMIT Permit No. ___________________ i \ (Complete in Duplicate) `i Da+e Issued ____7112)5. Application'is r by 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. 1 JOB ADDRESS AND LOCATION-L.-----------�-b-(�O �' � � ---------------------------------------- s J, -__._ Phone Owner's Name------------------••-----------M1�--H-=---•---��Y]-��r�-=--••--- ------- -------------------------------------------------------- ---------------- -------------•--- Address----------------------------------•------...----�....--------- -----••---------------- ----- -------•-•-----=------------------- -•--------------•------------------------------------- Contractors Name----------------------------------------------------�_ --- � _ -..- -------- Phone------------•---------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: ----:--I Number of bedrooms ---v?_. Number of baths ___I____ Lot size ______ �0?Q___-X_____/..,-76 -------------- Water Supp1 Sup-ply: Public system ❑ (Community system ❑ Private 2J 'Depth to Water Table by__'ft k Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ) Hardpan ❑ Previous Application Made: Yes 0 No jo New Construction: Yes 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--------------------Material-----------------------.----_--_--- �xI rv)' No. of compartments-- ------------Size-----•--•------ ------Liquid depth--------------------------Capacity----------------i Disposal Field: Distance from nearest we€l______-TP_�._Distance from foundation___:P_J-_l_._._Distance to nearest lot line---- -------- Q Number of lines_______________I-------------------Length of each line---------- Width of trench---------- `*---_----------� {4. . Type oT filter maferial_____-Iii,._'_ ___Depth of filter material-------J_$.___--------Total length----------- ��____________________ Seepage Pit: Distance to nearest well-------------j______Distance from foundation------------.-------Distance to nearest lot line----------------. ENumber of pit t- --------------------Lining+,rmaferi`I ---------------------.Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Dist nue _ from foundation__ _._________.___.Lining material-------------------------------------- Size: DiameterI-------------------------- - 'De ----------------------- _-.-------------Liquid Capacity --------------gals. Priv Distance from,nearest well *w...r Privy: � --------------------Distance from nearest building----------------------------------------- ED] Distance to neares lot line------ee--------------------------------------------------------- Remodeling: and/or repairing (describe):- ._�_------------ ------------------ t -----------------------------------------------------------•---------�--------- %�d= ��--------�''�� " --------------------- -------•------- ----------------------•--------------'�-•-------------------------------------------. ................--------------- ------------------------------------------------------------------------ ' _ ' r -----------------------------------------------------•------------------------------------------------------------------------------------ I hereby certify thaf?!Fre 1p,epsd{this-application-and that the-work will be,done in accordance with San Joaquin County ordinances, .Stat.41 w , and rules Ad a ulations of the San Joaquin Local Health District. Si ned O ner and/or Contractor BY - (Title)•-------------- - --- ---------- (Plot plan, showing size ofjot,'Oocation of system in relation to wellf, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- ----------._-- ._ DATE-----_____-- _ REVIEWED BY-------------------- -- • ;�-- - -- --------- - --------- -- ------------------------------------- - - ---------------------------------------- -------- ---- ---- ----- ---------------- DATE----------- ---�--•----- ------�----------------- BUILDWGPERMIT ISSUED ------•----- ---------------------------------------------------------------------- DATE •----------------------------------------- Alterations and/or recommendations:--------- - _- ---------------- -------•---------------------- -----------------------------------------------------•--•----------- ---------------------------------------------------•---------•-------------------------------------------------------------------------------------- ------------- ------------------------------------- 1 I -- ----------------------------------------------------- ------- ---- ---- ..-J/,-*N A 7 FINAL INSPECTION BY:_-__ _ ___t_ ______ 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 10-52 Revised W-2100