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APPLICATION FOR SANITATION PERMIT Permit No. .3_`_5-•_.-- . f (Complete in Duplicate) 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-------AS!_-4---9r.-_ r- .,.+ ,r�1 .,__ Owner's Name c: ' f3- Phone1�2 --- 7 Address. of fa - e --------- Contractor's Name ------ c`— -------------------- Phone w Installation will serve: Residence' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_ Number of bedrooms _-�, Number of baths -_1-__ Lot size --__-_,-5-0-- 5—Qr - 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 E❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: 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 w II_ f}t(/-__Distance from dation__1_al.__-__.Material----------------_-_- -___-� __' No. of compartments-_ _ -- � ---- ---------Siz�e _-•-- - Liquid depth--�-2"-��--------Capacity_ r Disposal Field: Distance from nearest well_�fDice rom foundation-.f'�� -____.Distance to nearest lot line__--X7___ Number of lines-----_---_--xf Len th of each line--- 9 0�- -- ---_--_-.Width of trench--- _`-' Type of filter material---•_�Ill----___------ _Def filter material------------------------- length-------------------------------- Seepage Pit: Distance to nearest well-_- _,___pistancg fro?njundation_-- p_` ,max' ff Distance to nearest [of line- �-.---_---.. W Number of pits-----------!_.-----Lining material---- _- _---Size: Diameter------ _ — --------------- -� Cesspool: Distance from nearest well--------- ------- from foundation-____----_---__,Lining material-----------_----_-__-_-------_------. ❑ Size: Diameter--------------------------------------Depth-----:-_--------------- --------- � - Liquid_Capacity-------- ...... . w�-R gals. _ k 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 r� `- and regulations of the San,Joaquirt Local Health District. r �. I i el ----- By: - " ;��:7�40wnewwliift4orrector} Cont - --- ------- - -- - - (Title} x1�_� + (Plot Alar? ing size of lot, location of sys m in relation to wells, buildings, etc., can be pl ced on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- -- -- f_ -- ------ ._ DATE-------------- REVIEWED B)'----- --------------- - ------------- --- ------------- -------------- ---------------- DATE � -------- � Z - ---y- -------------- ------- --- ---�-------- - ------------------------------ BUILDING PERMIT ISSUED ------------ DATE ---------------------------------- A terations and/or recommendations----------------------- --------------------------- ----------------------------------------------------------------------------------------------------- ------------------------I---------------------------------------------------------------- ----------____ --------------------------------------------------------------------------I----------------------------- ---------------------------------------------------------- ---------- ----------- ------------------------ -------------------------------------I--------------------------------- --------------------------------------- -------------------------------------------------- ----------I------------------------------------------------ -------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------- FINAL INSPECTION BY:_-------� --•---------------------------- Date------------- - q 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 E5-9--2M 8-51 Revised W-2100