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T f-ten .- -_ +.. - •y APPI„I ATION FOR SANITATION PERMIT Permit No. 7_:r--_-- (Complete in Duplicate) Date Issued ______ Application is hereby made to the San Joaquin Local Health District for a permit constr t nd install the work herein described. T}is application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATION___ - ----- ---- ----------------- Owner s Name _ ----- Phon c- T ------------------------------------------------------ --------------- Address------... --- ------ Contractor's Name------------ �----- --------- --•--------------------------------------------------------•-----------------------------•-----•--------------- ---- -- . �< I *. ----------- Phone--- �__ Installation will serve: Residence' Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ `' Number of living units: ____�, Number of bedrooms __/___ Number of baths Lot size /- y Gam- -------{ -� ---------------------- .,.Water Supply: Public system, Community system ❑ Private ❑ Depth to Water Table 0�- ft• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado b Hardpan ❑ � Ed .�; Previous Application Mede: Yes ❑ Na� New Construction: Y� No F-141� �•�- ' •TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 fee+.} _ j : �._Septic Tank: Distance from nearest well___ _��__-_.._Distance f om fo ndati Material ---- - -- --- - No. of compartments___ i uid de th__�_-- q P - ---�---Capacity----- -�f--�--- 4, `. rDisposa! Field: Distance from nearest well _.Disfiance from foundation _d�_�___._-Distance to nearest lot dine___ Number of lines____--__/ , Length of each line_____ - x _ -Width of trench-_-2 __ Type of filter material _ -------Depth of filter material- length4 r_-______--- -^E r� ----•--Total _----- -------- ---- ----------- - 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 �. rx ❑ material__.___--_______________--Size: Diameter D--------------- -------------- p ----------------------------------------------------Liquid Ca aciY ----tgals. . Privy: Distance from nearest well______________-._.------_-___-__.-_-.______-_Distance from nearest building g --------------------- ❑ Distance to nearest lot line----------- - ---------------------------------------------------- Remodeling -Remodeling and/or repairing (describel:.__-----_____- - ------------------------------------------------------- ------•---------------------------•-------•----------_----•--- - ------------•---------•------------•--•------ •----------------------------------------------------- --------------------------------------•----------I--------------------------•-----------•------------------------------------------------------------------------------------------------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law , an ules r ulations of the San Joaquin Local Health District. `> Si ned ( g ) --- -------- (O / C �r ----------------------------------------------- BY: ---------------- l _. - (Owner n o ra --,-- -�"."'r- -- era tor} -----••----------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.j"can be placed on reverse side). k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--__._ �� DATE _. REVIEWED BY- .- = ------ DATE- r - ---- -- - - BUILDING PERMIT ISSUED_______ DATE-_.______ _ Alterations and/or recommendations:___ � - r._ � r r /�11''--�--•-�'��'�.�� # ;�-- ----_--------•-- --------- -- ---- ------ ---------- ----------------- --------- ----........ . -- - -- ------------------------------- FINAL INSPECTION BY:- ------------------------------------------- Date---------- SAN JOAQUIN LOCAL HEALTH DISTRICT h 130 South American Street 1 300 West Oak Street 132 Sycamore Street 814 North "C" Street E Stockton, California Lodi, California Manteca, California Tracy, California r' ES— 2M 8-51 Revised W-2100 I