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APPLICATION FOR SANITATION PERMIT Permit No. l_Q-?'--- T (Complete in Duplicate) Date Issued V - -- 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 Ordinanc `ffo. 549. JOB ADDRESS LOCATION_'._ f -- ------------- - Owner's Name --, ----- - -• -- -- ---- --- -•- -- --- ---► �-j------------ ±k ------------•------------------------------------------------------------- Phone- ------------- Address-------- _. Contractor's . Na Y- -------------------------------------------------------------------------------------------------------------- Phone , Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ote) ❑ `Others ❑ Number of living units: _;�= 1er of bedrooms --2- Number of baths _ --_ Lot size --- &lam'_ �%"le --------------- --------------------------- Water Supply: Public system unity system ❑ Private ❑ Depth to Water Table ______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes ❑ No W New Construction: Yes 51�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) r Septic ank: Distance from nearest well____ _ _ _ `Disfan e fro fountion___-�nn__ X ide tk Mat r�aL_L( ' No. of compartments------- - --j e_______"--iC Liquid de th----•- "-- CapacitY Q Disposal Field: Distance from nearest weir istance from foundation_ Distance to nearest lot n I_�Number of lines__________4-1 Len th of each line____ __ _ ______g-� Width of trench____,�e"-_ __Type of filter material� -7 1-------- ----------• Depth of filter material ---______/__________Total length -------- .1t ----------------------- Seepage Pit: Distance to nearest well___________Distance from foundation ------------- .------ Distance to nearest lot line_________________ ❑ Number of pits_______ --------------- Lining material _____________---_______Size. Diameter____-_______ R Depth ---------- --------------- Cesspool: Distance from nearest well ----------------- Distance from foundation -------------------- Lining .material ---- .___-____________ ❑ Size: Diameter_______ ___ ___ ----- Depth _ Liquid Ca acit -.------------------ Privy-' Distance from nearest well ------------------------------------------------- Distance from nearest building ❑ Distance to nearest lot line___� - ------------------------------------------ Remodeling and/or repairing (describe):_______--"-_""______ , --------- ------------------------------------ ------------------------------------- ------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------- 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. Signed)-'- {Owner and/or Contractor] $Y= ------ ------------•------•----------7 ------------ (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., can beeplaced on reverse side). FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY__C-!�__ .. ------- _._ DATE REVIEWED BY ----------------------------- ---------------------------------------------------------- DATE 7� BUILDING PERMIT ISSUED -- ISSUED_______..________ --------------------------------------------------- ---------------------- ---------------------- DATE san %j------------------------------------------- ' ------------ ----------- ---- �e _._--- ------ --------- --------- --- ---- ---- ------- --- - ---------------• --------- --- --- ----------------------------------------- ------ ----- ---------------- - ----------------- - - --- -- -- --------- F1NAL INSPECTION BY: --- oO — Date- ��-------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 'South American Street 300 West Oak Street 132 Sycamore Street Stockton, California �. $14 North C Street Lodi, California Manteca, California Tracy, California ES -4-2M 8-51 Revised W-2100