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APPLICATION FOR SANITATION PERMIT Permit No. .__?:2'L--�.3- (Complete in Duplicate) Date issued 14 3— Qct 3 Application is hereby made to the San Joaquin Local Health District for a permit o construct and�insWl the�rk�rinwxibed. This application is made in compliance with County Ordinance No. 549. E ei �...�� JOB ADDRESS AND LOCAT ON..., __1'l .- - ---h ->�!.- --- ---L4.- ---C� 47h-3.-- �Y ---------- ) `�rV o c ? "`Owner's Name----------------- o��L_ �9«e' 4�yLt Phone 'v a---- - -)-'---------- Address------------ ------------------------------A-p-3-4-------- f------ ------:: -'------------- Contractor's Name---------------------------------------------------------------------------------------------------------------------------------------------- Phone-------------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms __/___ Number of baths _1_--_ Lot size --------3/- --------61____________________________ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ________ ft. (�} Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [X Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: Yes ❑ No © New Construction: Yes h No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well-----„"��-__ istance from f ou�nclatio�______�__________-Materia__� � -G_.--: No. of compartments--------- ----------- x- ----`f-------- -----Liquid depth-------3--- - -------- Capacify---- -03-d _ -- .._- Disposal Field: Distance from nearest well____564'__Distance from foundation_--- r'` �-________Distance to nearest lot line/__5�__r___I �w 19 Number of lines______________! y� Length of each Eine______ .__ Width of trench---------2_"z�- Type of filter mateDepth of filter material__-_--J_ -----------Total length---------&d_--___________________ 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____________________________________' ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------_Liquid Capacity----------------------------gals. �oe Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------- Distance --_- _________ _________________Distance to nearest lot line----------------------------------------------------------------------------------------------------------------------------------------- ribe) W� -lP � ? ;?---------------------------------------------------------•------------ ' ---•---•--------------------------------------------------------------•------•--------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, St laws, abd rules and regulations of the San Joaquin Local Health District. r (Signed) m- �---- - -- - -------------------------------------------------------------------------(Owner and/or Contractor) By:-------------------------------------f..----------------------------------------------------- ------------------------------------ (Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FPR RTM T USE RNLY APPLICATION ACCEPTED BY-------- t ------ DATE---------- J� - -'- REVIEWED BY- ------------------------------------------------------------- ----------------------------- ------ DATE---------------------------------- BUILDING PERMIT ISSUED--.--_.----------------� %---------------------------------------- `--i---------------- ------ DATE-------------- ------------.--r---------------------------- Alterations and/or recommendations:----------C---------- ---- -- --------�' ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------- ------------------------------------ --------------------------------------------------------- - ------------------------------------------- ------------------------------------------- --------------------- FINAL INSPECTION BY--------------*____ --- - ------------------------ Date--------------mss �/ -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 304 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