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,-5 h APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 7 Date Issued Thi Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described, s application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__ 1r_ ---------------•---- Owner's Name-------� _ -------------------------- ------------------ -------- - -------- Phone- Address----�-F�--�0�--•- - ----- �------- ----- - - ---- -------------------------------- --------------"--•--------------- ------------•-------"-------"--- -------------------------------- - ---------------•--•----•- Contractor's Name____ �.�,rl�"_"'� ___ ___._ -_l�-�-� - - - ------------•----- - ---�--------------------- •----- •---------------------------- InstallationPhone_,_ will serve: Residence Apartment House [) Commercial -----•---'------------------ Number of living units: _f Number of bedrooms "_ ❑ Trailer Court ❑ Motel Other ❑ Number of baths .�___ Lot size __ �/.z_ �/ ��7Q Wafer Supply: Publics stem ----- ------------------------- Y Community system ❑ Private ❑ Depth to Wafer Table 4�a_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No 0 New Construction: Yes 0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if Public sewer is available within 200 feet. Septic Tank: Distance from nearest well-NO 44, II_Distance�from *foundation I -.Mate�ia�" . 10 No. of compartments___"__�---------------Size_S X D S' '.y y X Liquid depth yl�_ Capacity-?. Disposal Field: Distance from nearest well&W.g.�f_Distance from foundation__-__�-S Y i r -._.Distance to nearest lot line_-____-,�•"_ Number of lines---•------�---------------- ----Length of each line------!rS ------------.Width of french. �5�" v1i Type of filter material_•"RoC P __-----_----__ ` ---_._--De Depth of filter material--l8'--------- -Total length------ " Seepage Pit: Distance to nearest wellNo_Qe-il---Distance from f__ggundation___-" D """•.Distance #o nearest lot line----------------- ------------ 4 �[ Number of pits. ----------Lining material t2 ¢." .Size: Diameter-----,34�� ' r Cesspool. Depth s`------------ - p Distance from nearest well----------------- Distance from foundation""_-_--------------Lining material-------------------------------_---- Q ❑ Sire: Diameter------ -------------- ------- ------Depth---------------------------------------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest v✓ell__________________ " --------------------------"Distance from nearest buildin ❑ Distance to nearest lot line------------------""__-- — g- -------------------------------------- Remodeling - ------- -----------------"_-- -- ----- emodeling 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)------ `� �'--- lam`-�---------iel "_* — 8Y:- ----------- �__ wne.r and/or Contractor) Y ---------- --- ------ - -- (Title) (Plot plan, showing size of lot, location�f s stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------------- - ----- --- -------------------------------------- DATE REVIEWEDBY----------------------------- ----------•---;;��- ��`-�-- -��-�--- - BUILDING PERMIT ISSUED-------------------- ---------------------------- DATE -------- ------- ------------------- --------------- --- - DATE--------------------------- Alterations and/or recommendations:______----. -----------•-------- FINAL INSPECTION BY: — ' ---------- ---------- Date__..---- ---------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheet 300 West Oak Street 132 Sycamore Street 814 North "C" S+reef Stock+on, California Lodi, California Men+eta, California Tracy, California ES-9-2M 10-52 Revised W-2100