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APPLICATION -FOR SANITATION PERMIT Permit No. V (Complete in Duplicate) to � Date Issued ___��_-A_ S L Application 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..'! __-__5817 )k,_-,Pers! 9-Ami---- Ston;c ;t -__�Swain__Oake -------------- 1 Owner's Name ------------L-°•9° MC--Teer ----------------------------------------------------------------- Phone---2-2615---------•---•---- Address-------------------------------I5--XQ.- 0_19!--Street-.-..---------- Contractor's Name-------- Phone._.9:n47_________________ Installation will serve: ResidenceXE Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1______-Number of bedrooms3_--_--_ Number of baths 1_____ Lot size _125txg5t y Water Supply: Public systemU Community 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-0 Previous Application Made: Yes ❑ N31C New Construction: Yes ❑ No ❑SuppleneIItary drainage 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_------____:_________--.-_-.--________________-_. Xf� g No. of compartments--------------------------Size--------------------------------Liquid depth------------------------._Capacity-•---------------- Disposal Field: Distance from nearest well----X9Ae---Distance from foundation_!Qt_-----------Distance to nearest lot line____5t---------*%4 XKI Number of lines----_Z---------------------------Length of each line-Q3#----------------------Width of french-_-----�t -------- Type of filter matenal__ n__ --------Depth of filter ma+aria!_-___IgA_______.__Total length--------- 5!_________________________ 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-------------------------------------- El Size: Diameter-1-----------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. I Priv Distance from nearest well_______________________ _____________________Distance from nearest building 9 ❑ Distance to nearest lot line------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------•---------------------------------------------- --------------- --------------------------------------- .....__.. = i k ---------------------------------------------------------------------------•--------------......----•-------------------------------------------------------------------------------•--•----------m ------------------- r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coulafy ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Si ned UQ A I & 501�$f INCe_--------------- ---------------------------------------------------------- Contractor 9 )--•--------------- ------ --------- ( ) By:--------- - -----------------------------------------------------(Title}----ESTIMATOR---- -------------------------------- (Plot plan, sho i size of lot, location of syste in relate to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ ------- ----------------- ---------------------------------------- DATE-,.�----------------------------•--------------------- REVIEWEDBY r `--------------------------------------------------- -------------------------- DATE----- ---------------------- p BUILDING PERMIT ISSUED---------------`---U------------------------------------------ --------------------------------------- DATE.----------- ' Alterationsand/or recommendations--------------------------------- ---------------------------------------------------------------------------•------------------------------------------------- ;. j i I ------------------ --`----------------"-----------------'-------------•------------------------------------------------------------------------------------------------------•--------------- --------- r FINAL INSPECTION BY: � L Date -� --------------------------•-------------------------- 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 E5-9-2M B-51 Revised W-2100