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RL r , pp APPLICATION FOR SANITATION PERMIT Permit No. ._�ll__�1-.�__... (Complete in Duplicate) 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 Ordinance No. 549. e�3 � p�Z� �o Differ.7".6 JOB ADDRESS AND LOCATION-----TY(`-=1&------�-------(bA ---- "�1 ------ t---Ab----r1ial--�f3�it ��le�dt; he Owner's Name------------------------L4Yt1f—_[--•-------caw-a-mn=------------------------------------ ------ ------- Phone--------------- --------------------- Address -------- - - ---------------------------- ----------- Address------....---•-----•-------------------------------------a5,f-----&)IO-14fiC------------------------------ ----------------------------------------------------------------------------------- Contractor's Name------------------------------------------------------------------------------------------------ ----- Phone----------------------------------- Installation will serve: Residence [M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i i Number of living units: ________ Number of bedrooms -A--- Number of baths -------- Lot size -------- --- ---..7,T------------------ Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table ---?-_ ft, 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy 4oam(w' Clay Loam T Clay ❑ Adobe❑ Hardpan ❑ ti F Previous Application Made: Yes ❑ No New Construction: Yes � No ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: t J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j Septic Tank: Distance from nearest well----_10-----Distance from foundation------ ---------Material-------tmtke4---------------------- - No. of compartments_____.___�------....__Size_.•...3__,X---Y_.X_.1___Liquid depth------------ _`!._.__Capacity------ .SQ--/ .� / / I i Disposal Field: Distance from nearest well-----r4> __-__Distance from foundation------ _-__.___.Distance to nearest lot line_______S'-_.___ Number of lines________________ _ Length of each line---------------40---------Width of trench:______Xw---____.____.__._ Type of filter material-------]7i-------------Depth of filter material _______Lt__.,____._Total length------------��'__________ _________. Seepage Pit: Distance to nearest well----------------------Distance from foundation.......------_____.Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest welL________________Distance from foundation___._._._____;_____.Lining material__.___________._____._______________, Y ----------------- - - ----------------------------------------------Liquid Capacity----------------------------gals 1 " . Priv Distance from nearest vreli__________________ ___ _ __ _ ❑ Size: Diameter----------------- --- ------ -------Dept - -•-- ;_____________Distance from nearest building____. ______.__._____________._____..___. r❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------ -----------------.-- Remodeling and/or repairing (describe)---------- ------------------ ----------------------------------------•-------I----------------------------------------------------- -----•-••---•-•-- �- ---------•----•-----•-------------------------------•------------- -----------------------------------------------------------------------------------------------------------------••-------•-------------------------------- ------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------- ----------------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with'San Joaquin County ordinance�, Ila aws, and rules nd regu ns of the San Joaquin Local Health District. 4 (Signed).. -------------------------------- --------------k--------(Ownerand/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title) Ir' (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---------------------------------------- -- -- -- DATE--------- --• - REVIEWED )3Y DATE__-. ------------------------ - BUILDINGPERMIT ISSUED-------------------------------------•--------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------------------"---- ------ ------------------------------------------------------•---------------------•-------------------------•-------- -----------------------------•-------------- --------------------------------------------------------------------•---------------------------------------•-- ------------------------------2----------------=----------------- F1NAL 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 10-52 Revised W-2100