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r APPLICATION FOR SANITATION PERMIT Permit No. ;—A-f-7----- in Duplicate) ,a,11 Date Issued 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 Qfdiaan e No. 519. l JOB ADDRESS AND CATION:---t ---------------------:------------------------------------- ----- ------ Owner's Name---- Phone--_; .- • ------------------------ --------------- Address----'-- , --------- - -------------------'-`------------------------------------------------------------------- = Contractor's Name--- ------------------------- ---------------------------------- ------------------------------------------------------------------------- Phone----------------------------------- par+ment will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Ell Number of living units: ___ --- Number of bedrooms ---Z- Number of baths ___C___ Lot size __as-D___ __�_aO f 4 Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Lo;/'�N Clay Loam ❑ Clay E] Adobe [jr/Hardpan ❑ (V Previous Application Made: Yes F] No New Construction: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I --Mate i� -----.----- Septic ark: Distance from nearest welL__r-`_________Dlsta l fro un_ tion_______________ . No. of compartments___________ _________Size_ _ _ -` '___.Liquid de9th------- ---------_--Capacity___!�1__�� __ - Dispos ' Field: Distance from nearest well___—__-----Distance from foundation__Z_,f_________Distance to nearest lot lin r ___-_- Length of each line--------------- -------Width of trench-------/![_ Number of lines___________ (------------ Type of filter materia__ __ t��epth of filter material----_t -----------Total length--------------- --- ---___________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- Distance to nearest lot line----------------- ❑ Number of pits--------- ------------Lining material---------.-------------Size: Diameter-----------------------.Depth---------------------------------- j Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____________------_____-_-__-_______- �n Size: Diameter--- --------------------------------.--Depth-------- ------ ------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- i"starce�zror� iecsast_l; i!dir..g----� _---- ,� �. ❑ Distance to nearest lot lire------- -------------------------------------------=----------------------------------------------------------------------------- --------- Remodeling 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 gulaations of the S n Joaquin Local Health District. e Owner and/or Contractor I --(Signed)--- --------6-Ad , By:------------------------------------------------------------------------------------------------------------------------------------(Title)------------------------------- (.Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --- ----------------------------------------------- ---------------�'r-------------------- DATE -' ----------------------------------- , l ' REVIEWED BY----------------------------------- '-'1 F �. 1 s DATE BUILDING PERMIT ISSUED-------------- --- - DATE--------- --------------------------=- --------- Alterations -------------------- Alterations and/or recommendations:___-------------------------------------------- '� ---------------------------------------------------= -- -------- ----------------A-- '------ =: -� '-' �_ - - - ---- - --- ------- ----- u = --------------- - _� ----- ---- ------- ------------ _ ------------------�----- -` -------------- FINAL INSPECTION BY:----C , ____ ( ------,----- , Da 1 4. SAN JOAQUIN LOCAL HEALTH DISTRIC I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, CaliforniaA� „Manteca alifornia Tracy, Californiaff ES-9-2M 8-51 Revised W-2100 �Q -�"! �( �E rf1> - `�" 111