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APPLICATION FOR SANITATION PERMI ,O Permit No. \ (Complete in Duplicate) 1' � Date Issued Sr.s_____ 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 `5 ---------- --------------------------------- Owner's Name ---------- �dr Phone- - � Address----- ---•------ Contractor's Name_._�.��i� - Installation will serve: Residence Ej-_-Apartment House ❑ Commercial ❑ Trailer Caurf ❑ Motel ❑ Other ❑ Number of living units: --/-- Number of bedrooms _-�- Number of baths ./--_ Lot size -------X Q,-------------------------- Wafer Supply: Public system Community system 0 Private❑ Depth to Water Table,04 ft. Character of soil to a depth of 3 feet: Sand ❑ Grave) ❑ Sandy Loam ❑ Cley Loam ❑ Clay ❑ Adobe[Er"H'ardpan ❑ i Previous Application Made: Yes ❑ No [ New Construction: Yes B-`N_, ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wifhin 200 feet.) p IY�/ �a Se tic Tsusk: Distance #rom nearest well_________________bistance from fo�ndati.on_'_______ _.._._.Mat�iaL_�-.-- - RNo. of compartments-_.--a ----.____..___.Size_S��f�y4�t�s�l_iquid/depth ___��A..__.___._Capacify-�Q�-, ___.____ Disposal Field: Distance from nearest well _ istance from foundation----l-d---------Distance to nearest lot line_____ ` _ Number of lines----------- -- Length of each line-----,j..5.*-- ---._._.Width of trench---.--.- _.fes_ __'--------__-•-- �I .. Type of filter material___S�TL� ___Depth of filter.material--- - ------------Total length-_-._�,5 _---_-_----_--__---------. -L,? y/ S Seepag it: Distance to nearest well.. 0t �___Distance/,�from fou dation---- -_---_---__-_.Distance to nearest lot line___ ___--__._ --------Linin maferial__C_03_�ize: Diameter-_-3-4. ri �•� Number of pits.-�--� - 9 �• ----�-�---Deptn- ------ ----- ------------------ Cesspool: --- -----�- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.-------_---_----.------_-_______- (� ❑ Size: Diameter--- ------Depth-------------- ---------------�-------------Liquid Capacity---------------------------gals. `} 0- t Privy: Distance from nearest i'1rel)----------------------- ---._ 6-----------------Distance from nearest building--___________.-----.------_-_----.-----.-. ❑ 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------AL-114--------/9-l.- --1 _�'_ _ ---- - --- --------------------------------------------------- ( ner and/or Contractor) By:------------- ----Gf/ '"'- ----------------------------------------------------(Tifle) - - ------------ T m - - - (Plot plan, showing size of lot, location of sys in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y. ._ ____ -- - REVIEWEDBY--------------------------------------------- ------ DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:------ -------------------------------------------------------------------------------------•- ------------------ ---------- ---_ ------------------------------------- -----------------j--�-----R-Y ----------- FINAL INSPECTION BY I/ --- - ----------- Date-------- ___- '! .. .-- -- --- ... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M : Revised W-2100