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Permit No. - -r-- f , • APPLICATION FOR SANITATION PER . .� (Complete in Duplicate) Date Issued 41�14--- b ``` Health District for a permit to construct and install the work herein described. AL�"cation is hereby made to the San Joaquin Local No 5for This application is made in compliance with County Ordinance 49. ---------- JOB ADDRESS AND L C 710N------ -- -- - -- ----- - - ------- - �- Phone Owner's Name________ - --------------------------------------------------------------------- -------- Phone----Z!!777 ------------------- Contractor's Name---- ----------- '�.- ------------- --------------------------------------------------------------- Installation will serve: ResidencANumber Apartment House El Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ v 1�- -------------------- x-LIS--1p Number of living units: ___ of bedrooms ___/-=- Number of baths ___�_-- Lot size ____ ___. W�ter Supply: Public system-JE�_Community system ❑ Private ❑ Depth to Water Table _____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam F1 Clay Loam El Clay E] Adobe[ Hardpan El Previous Application Made. Yes ❑ No T& New Construction: Yes ❑ Nok;z / } TYPE OF INSTALLATION AND SPECIFICATIONS: V (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i __.Material----�` Gl ' '� --------- Septic Tank: Distance from nearest well____ ___________Distance from foundation______L ------ Capacity 7 Li uid depth----41-4- ----- ----� - 64) No. of compartments_ �' Size__�_�1�---,.?�---�- g P �- ------ , J� � Disposal Field: Distance from nearest well------__._-___.-.Distance from foundation____ __ _; Distance to nearest lot line------ Length of each line---------------a--- Width of trench---- --------------- material------- of lines-------------�------- ----- 1 M ii r 4 Type of filter materia- --�'1�O Depth of filter material_______ - . . .Total length---------'----- ----------------•-----• 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____ -------als. e _ - ----- Liquid gcity---------------------- 9 ❑ Size: Diameter nearest well _-_--__--- _--.Depth------ _--_----- _-Distance from nearestbuildinacit _____----- ---------- --------- privy; Distance from ------------------------------------- ❑ Distance to nearest lot line----- -------- -------- --------- -------------------- ----------- ------------------------ ----- • ---------------------------------------------------•---------- f Remodeling and/or repairing [describe):____-- _---N-_ ----- - ---- - I hereby certify that I 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. Signedf- � ------ __ __ _______________________(Owner and/or Contractor) Title By- ------------------------------------------------------- -- --- - ---------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ti FOR DEPARTMENT USE ONLY , . I -------------- DATE----------- APPLICATION ACCEPTED BY-------------L AJ------ ------------------- ` REVIEWED BY------------------------------------------------------------ DATE---- ----------- BUILDING PERMIT ISSUED------- -----------------------------------=------------------•--------------------------------------- DATE--- ------------- •---------------------------------------- Alterations and/or recom endation :____ ____ -__-___ a --------------------------- I -- -� ' ------------------------------------- --------- ------ ------------------- - ------------------- ------------------------------------------- --- FINAL INSPECTION BY: -- Date_--- `----1-- � ��-------------------------------- " SAN JOAQUIN LOCAL HEALTH DISTRICT r 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y ES-9-2M 9-51 Revised W-2100