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Permit No.p�_r APPLICATION FOR SANITATION PERMIT + (Complete in Duplicate) S • Date issued 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 Cou t O_r-din ce No. 549. JOB ADDRESS -AND LOCATdOd____l! _ - ' __ ,- `� = ---------- ---------------------------------------- Phone Owner's __ %!__ -� Address_ T 7 Contractor's Name---'( = - Phone. ------------- Installation will serve: Residence tr Apartment House F] Commercial Trailer Court ootteII ❑ Other ❑ Number of living units: ----L_ Number of bedrooms _-Z Number of baths --1--- Lot size ----- ------------------------ 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 El Clay E] Adobe 2/Hardpan [ Previous Application Made: Yes E] No 7New Construction: Yes Q�o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sgwer-is available within 200 feet.1 I Septic*Tank: Distance from nearest well__S�W__Distapce from.foun tion____ _l _______.Materi _ _ _- - p ------ ' '- -----Liquid depth------------- - -Capacity j - No. of compartments __ Size_Y+4_ _ Dispos I Field: Distance from nearest well - O---Distance from foundaion___ ___.__ _- Distance to nearest lot line.__ - ' Number of lines__________�_ � ;________ Length of each line_c`___.-r_ - _;-�Ii ih of trench_______1�1_ ._-.. Type of filter materia...... ��'�' epth of filter material______Lf!'__ -_Total length----------/___f�___ ---- Seepage ..Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______________._. EINumber of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Q Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 1 ❑ Size: Diameter--------------------------------------Depth---------- ---•-•----------------------- -.--_--Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__________________________________.______- ❑ lot (( ot ------- -------- ------------------ ---------------- Remodel ------,--------- Remodelin nd or repairing (describe): '7-- -- " rL -------------- ________________ �- ___. -------------------------------------------•--.-._.--- - I' 1-1-1- 1-------------------11---- -11.111------ -------------------------------------------------------------------------------------------------------•---------------------------.--------------------------------------------------- ----------------------------------- 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. f_ 1.- ------------- ----------------------------------------------------------------------------------(Owner and/or Contractor) f- 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 APPLICATION ACCEPTED BY- -------------•-------- DATE----------------------------------- -- ----- ------------ REVIEWEDBY �------------------------------------------------------------ DATE BUILDING PERMIT ISSUED-------------- - -------------------------------------------------------------------------- DATE--------------------------- Alte afions and/or recommendations: �---- 9 -- ---•-- -----------------------'--------------------------------------•---------•------------------------•-------------•------------- !1 ------------- - -------- ----------- --- -- r� .�,�. v k` . ��.c - --{ --------------------------_ --V* -- ----- -- ------ - ------- r ------ -------- -------- fir --- -- -- ---- - --- l �--; = .: FINAL INSPECTION 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 9-51 Revised W-2100