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S ti .2 f APPLICATION FOR SANITATION PERMIT Permit No. ._!/Ts—i-3 7.- '-� f ' r (Complete in Duplicate) �g Date Issued _____ _sem_ _ s Applicatio is ereby 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 O.Ldinance No. 549. 07 JOB ADDRESS A LOC TION-- - - -> -____-- -- - ------------------- -- - Owner's Name----- / + --._. Phone-- �r -Z--9 Address--- Gtrl4c ...r_----------- -------------------------------------------------- ----------------------------------------------- Contractor's Name------ ------------------ ....... ----------- Phone__ _ _ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [I Motel L] Other Number of living units: _ ----- Number of bedrooms -- �_ Number of baths __/__ Lot size -------/0"-d7 )e--__ ---_______________ Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -.0Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe.' Hardpan ❑ Previous Application Made: Yes ❑ No x 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-____._------_Distance from foundation-------------------Material------------------------------------------ ----. ❑ No. of compartments------------ -----------Size •----•------------------------Liquid depth--------------------------Capacity------------•------ Disposal Field: Distance from nearest well----4_Q -Disfance from foundation__1X'- to nearest lot line------_�r__.___.� Number of lines___.________-/-------n-__-_____�-- Length of each line_____________�4-�----.Width of french-___-2_4/-Al_.___--_____-_-_ � Type of filter material.___51)9 Depth of filter material-------- '_ __Total length---------V_Q-J-_-____________________ Seepage Pit: Distance to nearest well-.__ Q_a --__Distance from fou dation-_____ .a.�____.Distance to nearest lot line----- -------- xNumber of pits________ ___________Lining material--S_0&44,44,Size: Diameter_______-3.t+__..__._Depth------A_,i'!.__.____--__-._ Cess ool: Distance from nearest well-----------------Distance from foundation___________________ Lining material__..______._____.______.__.__-______ Size: Diameter-------------------------- -----------Depth-----------------------•----------------------------Liquid Capacity----------------------------gals, Privy: r Distance from nearest well---------- from nearest building------------------------------.__.--_...__ ❑ Distance to nearest lot line----------------------------------------------------------------------------- ----------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- ------------------------------------------------•------------•-----•-------•------------------------------•-------------•----------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) �� ____�. caner and or Contractor -------------- --------------•------ ----------------• ------------- -------------------------------------------- -- ------------ By: -f , }} --------------------------------------(Title)-- -------- .... (Plot plan, showing size of lot, location of sy tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- --- ------------------------------------------------------------------------------- DATE —--------------------------------------------------- REVIEWEDBY----- - ------------------------ ------ ------------------------------------------------------------------------------------ DATE.-, -r-- ------------------------------------------------- BUILDING -------- --------------------------------------- BUILDING PERMIT ISSUED------------ DATES, Alterations and/or recommendations:---------------------------------------------------------------------------------------------•-----•--------...--------•------------------•-------------------- -•-----•------------------------------------- ------------------- -----------------------------------------------------------------------------------•- ----------------------------•----------- ----------------------------------------- - ------------------------------------------------ = --------- -------------------------------------- -------------------------------- ---------- ------------------------------------ ----------------I------------------ ---------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------•-------------------------------------------•---------------------------------------------------------- •------------------------------------------ FINAL INSPECTION BY:..----41 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 10-52 Revised W-2100