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`I� APPLICATION FOR SANITATION v ff Permit No {0..p-___�_-___ 1 (Complete in Duplicate) y S' Date Issued Application is h reby 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....--- , ` --- ------ fQ--��----------- ( -------- Owner's Name ----------------- ------ ------------------------------- Phone tar Address-------------------•-------------------•---------------------- ! -----` r �`' --la � Contractor's Name-------------------------•------•-------,--•-•------�yG ------------------------ ------------------------------------ Phone-----------------•------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: -__--_-- Number of bedrooms _-�Number of baths ---f-._ Lot size ----------- cs__.r_/_60-_--_-_ ---------------- Water Supply: Public system jq Community system 0 Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: YesK 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 well.- L-Distance from foundation-----/b........Material----- [� No. of compartments----------- -------Size--- __ Li uid depth--_----___"� '-----------Capacity �ad- Dis o I Field: Distance from nearest well-__-`f-----Distance from foundation-_--_lQ---------Distance to nearest lot line------- Number of lines-----------------v_-----------Length of each line----________-�d�--_--:Width of french----------- ------------ Type of filter material-_Jw__--------------- of filter material---------A?__...._._Total length-----------------------I�D_'_.___ 9 r Seepage Pit: Distance to nearest well-----------------__--Distance from foundation--------------------Distance to nearest lot line____-_--__-_----_ ❑ Number of pits----------------------Lining material-----------------------Size; Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material-------_---________-________.__-____-. �• ❑ Size: Diameter--------------------------------------Depth----------------------- ----------------------------Liquid Capacity----------------------------gals. 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 "� ` = Title By:---- -- _ ( � )-- (Plot plan, showing size of lot, locafisys on f tem in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- --------- DATE------------ REVIEWED BY-------------------- -- -y---------------- --------------- ----------------------------------- ----- DATE------------- ---------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alferat"ons and/or recommandations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------ ------------- ---------- ------------------------------------ ------------------------------ -------------------------- -------------- FINAL INSPECTION BY:------ -----------. Da e....... ---- ----------------------------------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3D0 West Oak Street 132 Sycamore Street 814 North "C" Street 5tockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100