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y� �� Permit Ne�_�_r._d-__-•_ r � � �` APPLICATION FOR SANITATION PERMIT A (Complete in Duplicate) pate Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install fh�e work herein described. This application is made in compliance with County Ordinance No. 549. ______________ JOB ADDRESS AND LOCATION----- -----L---l--,----,- ,� - / - Owner's Name------------- ''�A--L--- -.r---------� "`� 1-------`� -- ------------------------------------------- Phone--------y--- - AddressJ---------�--.. ----- ------------------ -------------------------------------------------------------- ------- SIT/--- Phone----------------------------------- -----Name - ----- lns+alla+ion will serve: Res'sdence'� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- -_-I---. Number of bedrooms __ Number of baths }---- Lot size --- ---'-�----1- f-------------------------- Wafer Supply: Public system ❑ Community system ❑ Private A Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan i❑ Previous Application Made: Yes ❑ No [� New Construction: Yes 4 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' Q ------.Material- i Septic Tank: Distance from nearest well Q------Distance from foundation_--.__- _- No. of compartments--------------- -------- Size- f -9k -------Liquid depth----- CapaatY.74 Disposal to nearest lot line-_ -_ ---_. Disposal Field: Distance from nearest well----�T------.Distance from foundation-_-- Cam Width of trench_--- _j_- Length of each line---------- ------- "� --------------- Number of lines---- ----�---- ------- 1_4�� ` Type of filter material-�_ _-.__ De th of filter material-------- .-- -----Total length--------:-- -------------------4t foundation to nearest lot line----------------- Seepage Pit: Distance to nearest well----------------------Distance from ❑ Number of pits---------------------Lining material----------------------Size: Diameter-----------------------Depth--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-.-----------------.Lining material------------------------------------- -Liquid ___-----------__---_------_-__ ❑ Size: Diameter--------------------- ----------------Depth-------------------------------------------------- Liquid Capacity gals, Distance from nearest buildin e '= ` Distance #rom nearest well- - 4 - - g - Privy: ❑ A)_-------I---'-----)-- ----------•------------------------------------------------- Distance to nearest lot line-------------------------- ---------------------------- Remodeling and/or repairing (describe):--____-___---_-- __------ ---------------------------------------------------------------- -------------------------------------------------- ----------- ------------------ -- -------:- ------------------ -- ---------- ---- --------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St t laws, and rules and regulations of the San Joaquin Local Health District. ---(Owner and/or Contractor (Signed ._' ------- -------------------t---_-------------- v ---- .Y } By: - - ------------ --- ------- -- --- -- - ----------------- -------------- - (Title} (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 DATE --------- APPLICATION ACCEPTED BY------------------------ -- - � REVIEWED BY-------------- ---------------------------- �/� DATE------ (� DATE--- -------------- --- ------------� ----------------------- BUILDING PERMIT ISSUED------=---------------------------------------------------------------------------- ----------------- Alterations and/or recommendations------------------------- - ------------------------------ --------------- --------------------- ----- - ------------------------------------------------------ ---------------- Date P -�`^ �----- -,. FINAL INSPECTION BY:-- -----__- - ----------� ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y r ES-9-2M 8-51 Revised W-2400