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APPLICATION,FOR SANITATION PERMIT Permit No. (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 Ord'nance No. 549. JOB ADDRESS AN :LO AT N_ ..... ........ - ------------------ -------------------------------------------------------------------- Owner's Name----- .11 1 ------------------- ---------- --------------------------------- Phone------------------------------------ Address------------ - ------ - ------------- Contractor's -- - --- -- ---- ------------------- ------------ Phone-----•-------------- ---_--------- Installation will serve: Residence Ej,_Apartment-House,E] Commercial railer - Motel E] Other El Number of living units: _' Number of bedrooms Number of baths J--- Lot size J-19-49-X ------------- -70 Water Supply: Public system: ;/ Number system El Private E] Depth to Water Table -------- ft. -- -------------- i. Character of soil to a depth of 3 feet: Sand Gravel [] Sandy Loam [j, Clay Loam ❑ Clay ❑ Adobe �ardpanE] Previous Application Made: Yes,[] No Sand Construction: Yes P90"ON I El TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if ub.4111cse er is available within-260 feet q Sepfic/ank: Distance from nearest we`XT ,_,_4 Distan5e fr,�foupdafiorlo,��at--------------Capacity____ ei?l---------- --------- ompartmenfs----- --------Liquid c�ep�h ------ --------Capa 1-4 -7- 1`4�7 of C _-A------ city-- bisfance to nearest lot Ii Dispos "Field: Distance from nearestwe --f------- �Prf- ---- ---- Distance from�foundafion_ 5. Length of e6ch line----- Width of trench------ Numl3er.oir lines----------- - -- J� _. ------ -------- -- til.... - --------------- Type of filter ma ri 4140bpth of filter material-----------I- -------Total length_______________ -------------------- * ,L. i, - t\,k Seepage Pit; Distance to nearest nearest- lot line______.____-___- Dis4�c_e'from fou�daticn------_-----_-----Distance to El Numb'er of pits----------------------Lining material-------------------.--.Size: Diameter-----------------------Depth--------------------------------- Cesspool: epth--------------------------- Cesspool: Distance from nearest-well------------------Distance from foundation--------------------Lining material_..____-__-________-__-.-____.______. `;` ❑ aterial------------------------ ------- 171 Size: Diameter------- -----------------------------Depth------------------------------------------- -------Liquid Capacity-----------•---------------gals. Privy: Distance from nearest well____ ________________________Distance from nearest building_________._____________-_---_-----_.-.._. � t ❑ Distance uilding------------------------------ ----------- Distarceto nearest lot line------------------------------------------------------------------------------------------------------------- Remocleliny and/or repairing (dfscrim 6).----V----------- -------------------------------------- ---- ---------- -------- ---- ---- ---AV),4v ------------- i ----------------------- + ---------------------------------------------k------------------------------------ ---------------------------0-----------0-------- - ----- ------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application' and fhaf the work will be done in accordan.ce with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, (Signed)---------- - -------- -------------------------------------------------------------------------------------- --------------------(&ner and/or Contractor) ------------------------------------------------------------------- ......... By:__ ---------- ----------------- 1 -------(Title)-------------------------------------- ------------------ (Plot plan, showings ze 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---- --------- ----: %31------------ REVIEWEDBY---------------------- ------ ------------------ ----------------------------------------------------------- DATE-- :::�—-------------------------------------------------- BU --- ILDING PERMIT ISSUED--- ----- ---------------------------------------------------------------------------------------------- DATE- Alterations and/or recomme nda i_ons- --------------- . - - - A ----------- - -------------- ----------- ---------- ---- ------f ---------------------A.U", -------------------------- ------------------------- ------------------------------------------------------------------------------- ---------------- -----------------------_-------------------------------------- ----------------------_-------------7y ----- ----Z__L_.U_V -------------- ------------------------------------------------------- FINALINSPECTION BY:..-:i------------------------------------ ------------- Date--------------- -;�------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10.52 Revised W-2100