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t j APPLICATION FOR SANITATION PERMIT Permit No. y (Complete in Duplicate) Date Issued _____ r 5 Application is herdlly 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 Ordinanc No. 549. JOB ADDRESS f�lel© LOCATION--- - --------------------•;-----------•--------------------t----------------- -'' - f 1 Owners Name �,. --------------------- Phone Address + -= --- ----•- -------------------�-------------------------------------- Contractor's Name ... - -•---- --------------------------------------------------------------------------------------------------------------------- Phone------------------------------- Installation ----------- ---Installation will serve: esin a Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote} ❑ Other El Number of living units: -------Aumber of bedrooms _90- Number of baths It_ Lot size ----719---_x ..... _____-_ I Water Supply: Public system FZCommunify system ❑ Private ❑ Depth to Water Table _.----- ft. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam © Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No Q New Construction: Yes [/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic ank: Distance from nearest well _.L�__.�.'-.�Distance,from founction_�(_ ____________ aten I ---- -------------------------------- No. of compartments --------__Size-3 �-----y_0... ----Liquid de th Capacity Disposal' Field: Distance from nearest welf��1_�f ,Distance from foundatio` �Dis cse,,o nearest lot�1-�� to ff� Number of lines_-___---__e1Z____---.___.___Length of each line U_: .b_-�!_4 'VGi h of french_____Zkt. Type of filter materi6t 4__€ 'tA: rDepth of filter material----_-f qq---------Total length______ _ _t.�.---------------...... G� �, Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot'line_________________ ❑ Number of pits:---------------------Lining material-----------------------Size: Diameter---- __-__----------_Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------,_.__-__-__-. I ❑ 'Size: Diameter--------------------------------------Depth----------------------------------------------------Liqui d,Capacify2* s.! " t Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------ -----------------------------------------------------------------------------------•-------- Remodelingand/or repairing. (describe)-------------•---------------------------------------------------------------------------•-••---------------------------------------------------------- ---------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- ----• 1 ----------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- 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 r g tions.of the San Joaquin Local Health District. (Signed)== z- r------------ ---------------------------------------------------------------------------------------------(Owner and/or Contractor) 1 By:--------------------------------------------- ------ --------------•------------------------------------------------(Title)--------------------------------------------------_------------ (Plot plan, showing size of lot, location of system in relation to welts, buildings, etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY --- --------APPLICATION APF�ICATION ACCEPTED B�-------------•-- -------- ------------------------------- ----- ------ - --- -- - -- DAT E--�^-------------------- -------- ---- -- - -- ----------------- REVIEWED BY----------------------------- - DATE- --------------- BUILDING PERMIT ISSUED------ ------ ------- _---- ------- ------ DATE-------v------------------------- Alterationsand/or recommendations---------------------------------- ---------------------------------------------------------------------- ------=-------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------------=------------------------------------------ ---------- ------------------------------------------------------------------------------------------------------------- S �3 FINAL INSPECTION BY:-- ------------- Date------------------/--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Straet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 r