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y�rC APPLICATION FOR SANITATION PERMIT Permit No. ___C��s_.. . 114 /lX (Complete in Duplicate) 1 Date Issued _________ pplica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and instaWPho erein described. This application is made in compliance with County Ordinance No. 549. ... - J JOB ADDRESS AND LOCATIO ----- L d� I-------------------------- Owner's Name--------------------------- y- ---•- ------ ---- �------------------ ---------------------------------- ------------•------------ Address-------------............ -----------Address-------------------------- � `� ----- --- .--------� -------...------- Contractor's Name__.----�- � � . Phane_- p__-vM l k7 Installation will serve: Residence El Apartment House❑ Commercial ❑ Trailer Court ❑ Mote Other ❑ Number of living-units: ._:{___ umber of bedrooms __ZNumber-of baths _L_- Lot size ____- ____ _._ -- U--- - -------=---------- Z .. Water Supply: Publicsystem . Community system ❑. Private ❑ Depth to Water Table _V f�Adobe Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Lo;r-PN'o Clay Loam ❑ Clay Hardpan ❑ 3 Previous Application Made: Yes ❑ No Sand Construction: Yes ❑ 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_________________Distance from foundation__._______________.Material------------------------------------------------ . I- WA.c No. of compartments------Y-------=-----------Size--'-:-------------- ------Liquid depfh------------------------- Capacity-------------- pis,osal Field: Distance from nearest well_________________Distance from foundation________-___.___._:Distance to nearest lot line___-.___-_______ Number,of lines`----------------------------------Length of each line-------------------------'---Width of trench------------------------!---------- . Type of filter material--------------- _Depth of filter material______________--_.-Total length_____________--.______________"._._-.___ Seepage Pit: Distance to near�t.wwell/. Q __-_:Distance f om foundation_.�'S�__.-.-__.Distance to nearest lot linoV.�____-____ Number of pits-- i---------Lining material---------Size: DiarrSeter__ --------------Depth--, ----------r_.--_ ---• Cesspool: Distance from nearest well--------------___Distance.from foundation_..,=,_-;_______-.__.Lining material--------- --------------------------- Size:_ Diameter--------------- - -------Dep.th---------------------------------------- -------i-Liquid Capacity----------------------------gals. `� 1 N. ❑ `-:Distance from nearest building _________`_-._--_._. Privy:- Distance from nearest well --- ---------------------- --------------- - .. g.------------...------- . [] Distance to nearest lot line---------- - . E f - - R ----- -. -- --- - - - ----------------------------------- ------------------------- J �. Remodeling and/or repairing (describe)=-- ---- --------•- --- -----fes ! - ----------- ----------------------•------ ------------ 1 t = -------------=----------------'---------------------------------- ' -------- _-____ ______�___ ___________________ __.._ ________ / , - yE -- _____________________________ ________________________ } r, I hereby certify that I have prepared this appl- ation and that the-work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin L al Health District.t d fisc , 1 ----------------•--- a /or Contractor) (Signed).....1 .�41 ; ner P B — -- ---------------)Title)- (Plot plan, showing size of lot, location of system in relation to w s, buildings, etc., can be placed on reverse side). E I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----=------------------ DATE-------,- REVIEWED BY------ ------=------------------------------- ----- --- DAT —-------- - ----------- BUILDING PERMIT ISSUED__'------------------------------ ---- S •DATE------ `---------- Alterations and/or �`" --------------------- * ° = = _ ------------ •----------------------------------------------=---•-------------------------- --------------------------------------------------------------------- - ---••---------------- ------------••---- -•-•-----------• -- •--•-- ----------------------••-----------•------------------------------------------------------------ -------------------------------------- ------=-----------------------•-- -------------•--------•---- i ----------- ---------------------------------------- --------- - ---- ---------- -------- ----- -- ----------------- ----- -- DaeFINAL INSPECTION BY:'---:. •--------------- — 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 . Revised W-2100 / j