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/,s APPLICATION FOR SANITATION PERMIT Permit No.(Complete in Duplicate) Date Issued a�-- ---- cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. pplication is made in compliance with CounPal Ordinance No. 549. JOB ADDRESS AND LOCATION------- a _ Owner's Name-----------------------------------------f4r-1. yi 7_ ----- &-AEr.Az-------------------------------------- Phone--- Address--------------------------------------------------- hone--Address---------------•-----------------------------------Z 1r1v — �2 _Contractor's Name _ ------ Phone__• CSS o Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _y____ Number of bedrooms ___Number of baths __/___ Lot size - -_��__�__�-------____.- Water Supply: Public system ❑• Community system ❑ Private EX Depth to Water Table 44Uft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,9L Hardpan ❑ Previous Application Made: Yes ❑ No Z' New Construction: Yes 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,5- _ -__ Distance from foundation_- Material____ ________A_ No. of compartments______y-------------size_ __ ____ -_ iquid depth-----5_ ___�-.______Capacity,_gpQ__ Disposal Field: Distance from nearest well.,0_�._Distance from touf�dation__ 0___.----Distance to nearest lot IineU_________ Number of lines---------------f_� Length of each line---.-�_Q-(---_____.Width of trench_�_�_!'___---------__- Type of filter material-----�� [1 -Depth of filter material__�g--------------Total length. �1�____--.. __________________ •� See a e Pit: Distance to nearest well....�J_ _---_Distance fro fo daiion----r__'�.D' tante to nearest lot line_1_0_�____ Number of pits.-/---------------___Lining material-- Size. Diameter_.-_ �! � Depth- Cesspool• Distance from nearest well_________________Distance from foundation--------------------Lining material-------------------------------- ____. ❑ Size: Diameter------------------- ------------------Depth----------------------------------------------------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well - _._____--_-_--_____._Distance from nearest building-------------------______--____-----_-__. ❑ Distance to nearest lot line Remodeling and/or repairing (describe)----------- ----------- --------------- -----------------------------------------------------------------------------------------------•----------------- f --------------------------------•-----------------------------.---_-----------•-----------------------------------------------------------------------------------------------------------------.----------------------------- ------------------------------•-----------------------------------•-----------•-------------•------------------------------------------------------------•--------------------------------------------------'----------------- { I hereby certify that I h ed this application and that the work will be done in accordance with San Joaquin County ordinances, State I d r les and re ulation of the Sa in Local Health District. (Signed)- ----- -- - ------ = - R --- aft$, -L=- �- --- Contractor) Plat la , show ize of I • -- -- + y: ------- ...... -------- ------ � - -----------------------------------------(Title)--- -- J 1 ( p o+, location of system in relatio wells, buildings, etc., can be placed on reverse side). FOR DEPARTIv'I•ENT USE ONLY APPLICATION ACCEPTED BY-_ _-- ----------------------------------------- --------------------------------------- REVIEWED ------------------ ---------------------------------REVIEWED BY ----------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------�` Alterations and/or recommendations:--------- ----------------------------------------------------------------------------------- ---------- F ________________________________----------------------------------------------------------------------------------------------------.----------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------.-----_-_-____--_-------------_____.--__._____------____--____----_--______-_---___-__----.-.----__---__--___- FINAL INSPECTION BY:--------VY- ------------------------------- Date----- / t� 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 8-51 Revised W-2100