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APPLICATION FOR SANITATION PERMIT Permit No; _____= I� (Complete in Duplicate) G - 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. JOB ADDRESS AND LOCATION______ -- _- ----------------------------------------- h . Owner's Name Q- Wit/ 6 b--------- d 1!/ ------------------ - hone---------- - -------------- Address ! ----------- --- --•-•- - ---- --------------------------------------------------- --- ------- Contractor's Name = _�� i .� C>i✓� x�y Phone. _ '; Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] /Motel ❑ Other ❑ Number of living units. ___ ____ Number of bedrooms J__ Number of baths 44 Lot size ---- Community -- Water Supply: Public system Community system ❑ Private Depth to Water Table _ ft. Character of soil to a depth of 3 feet:j Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes-[]'. No ❑ New Construction: Yes j ' No ❑ FHA/VA: 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._N_bAO,�Distance from foundation----^_`,n-,Z___.Material___.____'-1 No. of compartments___-__ --------------Size----__- _Z�--��-----Liquid dph�,__,6-3------------Capacity---�a-b---- I = s� b,i Disposal Field: Distance from nearest well__ �Diistance from foundation,=__' __ __ __Distance to nearest lot line__I ____,. Number of lines _____ __- r "Length of each.line_`_: _11__ :_ 0___--.Width of trench_._____L_1��___-_ -_- - - r ----- Type of filter material______ _ i3'�R__"_Depth of filter material----_�� --------Total length_____-/,�(�__------_-•-___------- ti Seepage Pit: Distance to nearest well____ _o_ -t____Distance from fou�ation__ '______.Distanfe to nearest lot Number of pits-- -_�_---"''Lining material�___1. _00 Size: Diameter_----- _---.Depth----�.�--------•_-- -t Cesspool: Distance fi•om nearest well____.________.:-Distance from.foundation____________________Lining material---_____.__________________-__._ ;! t ------ r ❑ 5 ze: Diameter -- Depth----- ----------------- -------- -----------------Uquid Capacity----------------------- -gals. est we ---------------------------- — --------------------------'D stance-from nea"rest building-_--------------------_-- y' _ ------------ riv❑ Distance to earest-lot ---------------------------------------------------------- Remodeling and/or repairing (describe):----!—1. - --__-_-_ --...�-------------- •-------•-----------------•--------- ------------------------------------------------------ -------- ------------------------------ -------------------------------------------------------- ------------------------------------------------------------ -------------•-------„-ti-----•---•---------------- r---•------------------------------------- --------- ----------- -------------------------------------------------••-------------------------------------------------------------------=----------------------------------------------- ---------------------•------------------------------- I hereby,certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfafe fa s, and rule regulations of the San Joaquin Local Health District. (Signed)---------- -- - --v----- 1� D _-L Z 4� -----____________. (Owner and/or Contractor) gY� --//Z ---------------------------- {Title) 407 i -- --------- - ------------------------ (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---------- REVIEWEDBY------------------------------------------------------------- f ---------------------- ( -,: DATE-------- -- ---------- --------'---------- BUILDING PERMIT ISSUED --------- DATE x Alterations and/or recommendations:--------_---------------------__ ______________-____--_ i -------------------------------------- ---------------------- ----------------------------------I---------------------I--------------I---------------I---------------I------------------------------- -------------------------------- ------------- -------------------------------------------------------- - ---------------------------------------------------------•---------•----------•--------------•--------•------------------------------- --------------------------------------------------------------- --- ------•-- FINAL INSPECTION BY:.-"tDate.. ---- --•----- a+ R SAN JOAQUIN LOCAL HEALTH DISTRICT i30 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 . Revised 1-57 F.P.CO-