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` p APPLICATION FOR SANITATION PERMIT Permit No �. --------- (Complete in Duplicate) Date issued __�li-Al Applica ion 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 LOCATION_...- _-- �, '� :"_ --- Owner's Name----------------------------- 4 �tA-A -Ogg ' Phone r"' Address-------------------------------------------------- A _ ---- -- - - - ------- Contractor's Name------------------------------ .-.----- -- ------------------------------------------------------- Phone =�� `�A • Installation will serve: Residence 2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j___ Number of bedrooms 4&_-- Number of baths J_.-__ Lot size - Water Supply: Public system IX Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adoba.W Hardpan ❑ Previous Application Made: Yes ❑ No ❑ 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 nearesi well_1A03ke,--___Distance from foundation_._I_m� ---,Material---� � •----- -- No. of compartments ---------------Size. f — Liquid depth__•a __. Capacity �� q►�1 l� 63?� Disposal Field: Distance from nearest well-. Ag4e__-.Distance from foundation_-,,-.P-'__.__._._Distance to nearest lot line_--- ° e--------------------Width of trench------�-y-�F---------------ITS,Number of lines-----------I_______________________Length of each line__ � ft -----Total length------! -------------------------- ce of filter matenal___�_�,__��C___Depth of filter mater�al__��--------- Seepage Pit: Distance to nearest well-.f!IoM_-_--'___Distance fr m foundation_____' ''-_-__.Distance to nearest lot iins_49�_______ ^ 2 h -.�----------------- J Number of pits----I----------------Lining material__cC - -----Size: Diameter-��----------Dep tn__.. Cesspool: Distance from nearest well_________________Distance from foundation-------------------- materia!__.__.____-______..__..____�_-;__, Size: Diameter �"` `Depth -------------------------------- F1Liquid Capacity----------------------- gals. . Privy: Distance from nearest well-----------------------------------------------.-Distance from nearesr building---__..__--__.___----_______--_____-----. �J ❑ Distance to nearest lot line--------- -------------------------------------------------------------=----------------------------------------------------•---------------- Remode4ing and/or repairing (describe)------------------------------ .-----.----------- ----------------•----------•---------------------------------------- -------------------• ------• -------------------------------•------------------------ -----------------------• ----------------------- -------------- I hereby certify that I hay repared ibis application and hat the work will be done in accordance with San Joaquin aunty ordinances, State laws, and ru es a d regulations o the San J aquin Local Health District. C/----------- - --------------------------• ------------ . Contract. or) (Signed) --- f (Title)----- (Plot plan, showing size of lot, location of system in relation to ells, buildings, et F, cane pi on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------- --- DATE----- -- DATE------------ ---�� --- --------------------- REVIEWEDBY------------------------------------------- ----------------------------- BUiLDINGPERMIT ISSUED--------------------------------- - - ----------------------------- DATE------------------------------ ---------------------------- Alterations and/or recommendations:------------------------------------------- -------------------•----------------------------------------- ---------- --------------------------------------------------- -----•----------------------------------------------------- ------------------------------------------------------------ -------------------------------------------- -- - --------------------------------------------------I----------------------------------------- FINALINSPECTION BY:.----- - ---- 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