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1 R /9 �! APPLICATION FOR SANITATION PERMIT �Permit'ENo. _e� - ---- (Complete in Duplicate) Dafie Issue !. - - j Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the worein escribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------------- -511 Owner's Name ----•--------- ----_� ----- ----- ----------------------------------- ---- -- Phone__ j Address----- � ----------------------------- 0 --------------------------------------------------•---------------------------------------------------------- ----------- -- � - -- - ---- oo 6Phone. tContractor's Name Installation will serve: Residence Ej Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. __I-- Number of bedrooms _ -- Number of baths _/____ Lot size _____________________ __________________________________ Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table y�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No g New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) JO ! Septic Tank: Distance from nearest weIIJVQW9/_Distance from foundation----/_O__i --------- at real______________.___________- ® No, of compartments_..------a2____-------___Size S6_ Xgb_Y:S________Liquid depth---Zlb-----________-Capacity_ �aa__ _ Disposal Field: Distance from nearest well84__0Q11_Distance from foundation___,/S_--------Distance to nearest lot line_______.-__.__._� Number of lines___________ ________ Length of each line------ __.________.__ --_-- - -------- ?y" � n Type of filter -----_-Depth of filter material---/�F____---------Total length--------7___.___._.--_____________-____ xx�� ' / Seepage Pit: Distance to nearest welll_Y_a__O&1�_-Distance from foundation____-��___.___.Distance to nearest lot Number of pits_._.____e/-_____ Linin material_�, ? _..Size: Diameter .._________Depth_.-. _S____.____.-- ---- CesspCesspool: ool: Distance from nearest well-----------------Distance from foundation--------------4�__Lining material------------------------------------- F1 _-- _______.____._'________❑ Size: Diameter------------------------------------- Depth-------------------------------------- --------"----Liquid Capacity-.-.------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------________._____:.__. ❑ Distance to nearest lot line-------- ------------------------------------------------------------ ----------------------------------------------- ----------- ---- - t Remodelingand/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, State laws, and/rules and regulations of theSanJoaquin Local Health District. (Signed)---- ---R---- _ --------------------------------------- - -------Owner and/or Contractor) By:---------- —_----`-�---� ' ------------------- LTitle) (Plot plan, showing size of lot, location of s tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----__--------------------------------------------------- - DATE :- _._��? � { T/ '. REVIEWEDBY-------------------------------------------------------------------------- --------- i -------------- ---------------. DATE-------------------- ------ ----------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------- --- ------------------------- ----------••-------------•------------------------------------- --------•---•------------------------------ ------------------------- --------------------•--------------------------------------------------------- -•----------------------•------------------------••----------------------------------------------------------- ---------•-----------------------------------------------•-----------------------------------------------------------------------------I-------------•--•-------------- ---------------------•----------------------------•-- -----•---------------------- -----•----------•----------------------------- ---------------------------------------------------------------------•---------- --------------------------------------------------------------- ---------------- --•----------------------------•--------------------------------------------------------------------------- FINAL INSPECTION BY:---- ------------• Date.... .I f_ _.I. -_ .4/ -- ---=�---0 -&- - --- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 930 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