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6— APPLICATION FOR SANITATION PERMIT Per No_V-1-f P:v I 'IV/ (Complete in Duplicate) - Date Issued _-___!-__- ,5---_-_ Application Iis hereby made to Jhe San Joaquin Local Health District,for a permit to construct an stall the work herein described. This application is made in compliance with County Ordiny.,eo. 549.,r 'Al ----------- JOB ADDRESS AND ----------"_ --•-f------------------------------------------------- '57 Owner's Name--------- --- ------- ----------------------- -- ---- ------------------------------------------------------------------- -------- Phone ------------- Address------------- ----------- ------ - - - - -- ------------------------------------------------------------I------------------------------------------------------------------------------- Contractor's Sa e------------ -- ------ I---- ---- ---- ----------------------------------------------------------------------------------------- Phone----,-3,__:�----- - —3 ---------- Installation will serve: Residence 21�Apartment Hou-5e [] Commercial 0 Trailer Court ] Motel E] Other E] Number of living units: _.---- Number of bedro' oms-.,--*-_ Number of baths j--- Lot size -------- --------- Water Supply: Public sysfernx Community system 1-1 Private E] Depth to Water Character of soil to a depth of 3 feet: Sand [-] Gravel E] Sandy Loam 0 Clay Loam E] Clay E] Adobee Hardpan 0 Previous Application Made: YeNo New Construction: Yes El NA A WRW TYPE OF INSTALLATION AND SPECAFITIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet. Septic Ta'nk-t Distance from nearest-well----------- Distance from foundation_-_-_----------__---Material__________--------_----_-_-_---.----- ------_------- El No. of compartments--------------------------Size-,------------------------------Liquid depth--------------------------Capacity------ ---------------- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line----__--_-__----. f ❑ ine----------------- 1771 Number of lines-----------------------------------Length of each line-------------------------_ ----Width of trench----------------------------------- Type of filter material--------------------------Depth of filter material----------------------Total length_______--_-_:-__--_-__-_--__- -_________ Seepage ength------------------------------------- Seepage 'Pit: Distance to nearest well, --__Distance iXm foAdation--- t-5F-/------Qjsta�,ce to nearest lot Number of pits----7""--------------Lining Size. i-ame+e- 111k�r, material ;�K--- D �r---—-------------Depth------ ?�---------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material__-.--.._--_-- x/ - Size, Diameter--------------------------------------Dept h-------:--------------------------------------------Liquid Capacity----------------------------gals. ) "z/� Privy:kv Distance from nearest well--------------------------------- ______________Distance from nearest building------- ----------- ------------- -_ ❑ Distance to nearest lot line_- -----Z------------ ------------------------------------------------- ---- ----------- -------------- Rerno 91 ing and/or repairing (descril: ---- ----------- Vevo," ------ ------- )e):---- ............;----_---------- -----—-------- ----------------------------- --------------------------------------- -------------- -------------------------I--------------------------------------------------1-------------------------------------------------------------------------------------------------------------------- -----------------------------I---------------------------------------------------------------------------------------------------------------------------------------------.........--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfate-fai�s, and le's and-regulations of the San Joaquin Local Health District. (Signed)---------- ---- -- -- --------- ---------- -------------------------------------------------------------------------------------------- -(Owner and/or Contractor) -W Z=7; By:-----------------------------------I------ ------------------------------------------------------------------ ----(Title)-- ------ -- ---- ------------ ---------------------------- (Plot plan, showing size of 510t, ocation of system in relation to wells, buildings,-e+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY 41- APPLICATIONACCEPTED BY_ -- --- -- --- ----------------------------------- ---------------------------------------- DATE ,,I-------------------------------------------------- REVIEWEDBY----------------------------------- ---- --- ---I--------------------------- -------- ------------------------------------- DATE----------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE-----------�-------------------------------------------- Alterations and/or recom dations:------ --------------------------------------- -- ------------- ------------- ,-q ----------- ---------------------- - --------------------- ---------------- ---------------------- --------------------------- - ---------- ------------------- ---------------- ------- - ------------- -- ----------- - -------- - - -- -------------- --- - ------- ---------- FINAL INSPECTION BY:---- �--------- --------------- Date----- -- -- ------ ------------------------- -------------------. SAN.JOAQUIN LOCAL HEALTH DISTRICT ;30 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