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` l 5 Permit No. APPLICATION FOR SANITATION PERMIT ..' _T (Complete in Duplicate) 4 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-_11-5- -------2� _<.)__rH d UC 7D_-v---------- e-C-1 -------------------- Owner's Name3-- '-- �- -- -- Address----x-------------------------------•-••---------....------•--------•------'---------------•----•-----._--------•----------•-----•-•-----------------•--•-••----•-••--•---••---------------•----•--------------- Contractor'sPhone f Name------------------------------�S�Lc �v ----------------------------- ------------------ Phone----------------------------------- -------------------------------------------- Number of living units: _-.._ .- Number of bedrooms _--_ - Number of baths .__�___ Lot size Motel ❑ Other ❑ t Installation will serve: gResidence' Apartment House Commercial Trailer Court Mj t � � P ❑ ❑ Water Supply: Public system CA Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:I Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, ' Hardpan ❑ { Previous Application Made: Yes [❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if publi sewer is available within 200 feet.) i Septic Tank: Distance from nearest well /Ve--,Distance from foundation__F" 0--_------.Material__ a�.- No. of compartments--.-..._-_ 'r ;quid depth_-.--_: Capacity . , Disposal Field: Distance from nearest wefI__A1477CPistance from foundati n-- Q_ __ ___.Distance to nearest lot line ------------ Length ______. Number oT lines________=_�_._..__. Length of each line___ ,,Width of trench.., _ �� -- - --- ------------ Type of filter material __l._�___ pth of filter material. �_- ___.-._Total length--_.___ ___ ___ _______________ Seepage Pit: Distance to nearest well.__.--------------______Distance from foundation--------------------Distance to nearest lot lin ______.______.._ I ❑ Number of pits----------------------Lining material-..-----.----..-------.Size: Diameter-----------------------Dept h------------------------_-------- Cesspool, - Distance .fnom nearest:well=_____:;_ __-'Distance from.rfoundation_--__:_-- :Lining;material--.--.___-:. ❑ Size: Diameter--------------------------------------Depth------- ----------- ----------- ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------- Distance from nearest building---.------.--_-----___-____---.----.---- ❑ Distance to nearest lot line------------------------------------------------------------------------------- -------------------------------------------------------------- Remodelingand/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 la rules and regulations of the San Joaquin Local Health District. . ------------------ -----------------/ ` ------------ --------------------------------------------------------- ------ Owner and/or Contractor Signed� -- ( / ) By=---------------------------------------------------------------------------------------- -----------------------------------------(Title)----------------------------------------- ----- (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------ /..3. ` ,---------------- - REVIEWEDBY---------------------------------------- --------------------------------------- ----- ------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterationsand/or recommendations-------------------------------------------------------------------------------------- ---------•-• ---=•-----------------------•------------------------------- --------------------------------•---•--------------------------------•----------•---------------...----------------------------------- -----•- --------------------------------------------------------••--------- -----•----•--------------------------------- ---------------------------------------------------------- -------------- ------------------------------------------ ---------------------- -------------------------------------------- ------------------------------------------------------------------- --------------------------------- FINAL INSPECTION BY:..-.----- y---------------------------- ------------- 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 E5-9-2M 10-52 Revised W-2100