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APPLICATION FOR SANITATION PERMIT Permit No. 47�`5.7 (Complete in Duplicate) Ij Date Issued �plica'ion 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 Count Ordina ce No. 549. \P JOB ADDRESS A LO -- ---- ------------ ------------ _ . 1 — L� � PAT ------------------- ----- -------------I----------- -------------- Owner's N e -- ------- - - ---------- -------------- ------------ ---- --------------6 7�r Address---- --- ---- ------ Contractor's Name---- ------------------------- ------------------------------------------------------------- ---- ------------------------------------ Phone----•- --------------------------\ Installation will serve: Residence Apartment House E] Commercial L] Trailer Court E] Mo;el [j Olher E] Number of living units: ,Z umber of bedrooms - -- Number of baths ___!--- Lot size ------------------------------- Water Supply: Public system Com—mu,nify system El private E] Depth to Water Table ft. 4- - — Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam Clay LoamMI Clay 0 Adobe El Hardpan E] ,,'—� Previous Application Made: Yes'E] No lil/ New Construction: Yes Loam Clay Elm TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publ c sewe�is available Within 260 feq.) Septic,;'�nk: Distance from nearest we�501 a en L -------------- C fro f afion/&�. . �- * I?r No..of compartments------ ----- 1 Liquid Oep.fh Capacity-- ---------- - r�,r 991F---- __ _t__ 0 Dis Field: Distance f�om nearest w €&)o------_ ista' ce from �Iuldafionj&�.M'_'�' is-t'a-nc--e'to nearest lot 11 Number of lines__________ ------ - ------.- Length of each line__________._____._-- Width of trench------- 4----- P;� ----------- Z ----------- F Type of filfer;ma�eri epfh of filter material------ length--'------ ----- ------- yp Seepage Pit: Distance fo 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-..________________._________-______ ❑ aterial------------------------------------- 171 Size: Diameter----- --------------------------------Depth-----------------i----------------------------- Liquid Capacity---------------------------gals. Privy: Distance from neatest well---------- ---------------------------- ---Distance frornnearest building--------------------------------------❑ - Distance to nearest lot �ir�-6--`:__2-------------------------------------------------------- Remodeling and/or repairing (describe):___ ._________._____.._- ------------------------------------------------____________l,_ __ --------------• --•• -------------------------------------------7----------------------------------------------------------------------------------------------------- ------------------------------------------------------ ------------ ---------------------------------------------------------- ------ --------------------------------------------------------------------- ---------- ----------------------------------------------------------------=--------------------- --------------------------- -------------------------------------------------------------------------------------------- ------------------------with------•----------------------------------- I hereby certify that Fhave 'prepared This application and that the work will be done accordance San Joaquin County ordinances. State law and_Ujlar�,and regulatons of the San Joaquin Local Health District. ? 0- �7' 10 — (Signed)-, ---- ------------------- -------- ------------------------------------I------------------------------------------{Owner and/or Contractor) By:-------------------------------------------------*---------------------------------------------------------------4----------------(Title)------------------------------------ --------------------------- (Plot plan, showing size of lot, locafion'of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � ------------- --,�k- -------- ----------- REVIEWED BY--------------------- - ----- ------------------------------------- ---------------------------------------- DATE-- --------!------------ ------------------------ -------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----_-- ------------ Alterations and/or recommendations:---------------------------------------------- ------------------------------------------------------------------------------------------•------------------. ------------------------------------------------------ -------------------------- -------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- -------------------I--------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I----------------- ------------------------------------- -------- ------------------ --------------------------------------------------- --------------------- -----------------------------------------------I-------- ----- ---- --- FINAL INSPECTION BY:.. ---------- 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 ES-9-2M Revised W-2100