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APPLICATION FOR SANITATION PERMIT Permit No. -3-------7 - (Complete in Duplicate) Date issued . . Applica+ion 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. r JOB ADDRESS AND ±LOCATION---- ` �-� �' ��c r aih------------------------------------------------------- ---------- ------•--- Owner's Name--------- ------ _Q.1W__-ell---------------------------------•---------------------------------------------------------------------- Phone- ---" � .rt .y Address----- d = � 1"�' '—-------------------------------------------------• ---------------------------------------..-------!---//--------------------------- Contractor's Name--.-- -----I-------------------------------------------- ----------------------------- Phone----_I---�--�-.--� i , Installation will serve: Residence EK Apartment House ❑- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�- Number of bedrooms _ ___ Number of baths __L----- Lot size ---- __1_ +_ -------------------------- Water _________________________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 ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No N. New Construction: Yes X No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Y Septic Tank Distance from nearest well?Qr�_Distance from foundation----Lo' --------.Materipi---- __ ��©__ --- No. of compartments--_-_ .--------- Size---9 _ X_ --------Liquid depth__.____ ---------_____Capacity----------- Disposal Field: Distance from neare t well__.3C"f Distance from foundation-.- 0-______-.Distance to nearest lot line-_�� _ _______ Number of lines______ p '________ ______________Length of each line_�P, U 44'_ ._-_-Width of trench______ _ _�____-.____________ ______f_ ..........Total length--------I-X-10--------------------- Type of filter materia------- —PAADepth of filter material Seepage Pit: Distance to nearest well______________ Distance from foundation_.-..---.-----------Distance to nearest lot line--__--_-____-...- ❑ Number of pits----------------------Lining material-----------------;-----Size: Diameter-----------------------.Depth--------------------------------- r Cesspool: Distance from nearest well ________________Distance from foundation------------------- Lining material------------------------------------- ❑ Size: Diameter--------1---------------------------r-Depth-----------------------•----------------------------Liquid Capacity-----------------------------gals. t Privy: Distance from nearest well-------#_:'-------------------------------------Distance from nearest building-------------------------------------_---. ❑ Distance-to,nearest lot line ------------ and/or repairing (describe)=- - ----- -----=------------------------------------------------------------------------------•-----------------------------------------------=------- a ------------=--•-•--•--------------------------------------------------------- -----------------------------------------------------•••-------------•---------•-----------•-----------------------------•---------•----------- , ----------------- ---••-------------------------------------------------------------------------------------------------------------------------------------- ----------------•-------------------•------•--------------- - I hereby certify th t I have prepared this application and that a work will be done in accordance with San Joaquin County ordinances, Sta Iaw and rules and r ulatio of the oa ul Local Health District. +s Signed _________-- . _____.___:_____________'___-_-._----- Owner and/or Contractor By:----------------------------------------------------------------------------------------------•------------------- -----••--•--------(Title)------------------------------------•--------------------------- (Plot plan, showing site of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -0. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- _-- 4 -- '---------------- DATE---- _ __- --a _�-------------------------- REVIEWED BY-------------------------------- = - DATE - ----------- ---------------- BUILDINGPERMIT ISSUED-----------------------------------------'------------------------- ..-.._..-------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:----------------------------------------------------------------------------------------------------------•----------------------------------------------- 0 r ----------------------•••-•--------•------------------•--------------------------------•-------------------------------------------------------------•----------------------------------------------------------------------- .. 7 N 3 FINAL- INSPECTION BY------------------------------I _�n-�----�---- 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 Revised W-2100 i