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OC " APPLICATION FOR SANITATION PERMIT Permit No. ---0---- - ! s a_tjo - 3d C/ ,_I�k 1"S' (Complete in Duplicate) Date Issued .___- -f __� D�_ —re _� Application is hereby made to the San Joaquin/Local Health District for a permit to.construct and install the work herein escrib d. This application is made in compliance with County Ordinance No. 549. �1 ;n/. JOB ADDRESS AND LOCATION---- = " �^------IiH °"" Owners Name p -------- . + :` ------------------------------ Phone 3 ----------- Address---------------- 0 �.. -z' .----- ------------------------------------------------------------------------------------- --••---------------------- -- - Contractor's Name--------- -------------------- Phone----------------------------------- Installation will s tve: Residence Apartment House ❑ Commercial ❑ Trailer Court El Motel. ❑ Other [-] A— Number of baths - �' Lot size _� �_._ -f Number of living units. __ ____ Number of bedrooms - - - Water Supply: Public system ❑ Community system ❑ PrivatehA Depth to Water Tabled_ ft. Characte'r'of soiPt.o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ x Z Previous Application Made: Yes ❑ NoNew Construction: Yes No ❑ TYPE-OF4NSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well--G__B__•-----Distance from foundation__--0-----------Material-------------------------------__ No. of compartments-------�_�------------- Liquid depth------------ ---------------Capacity______ ___ - --- '/Disposal Field: Distance from nearest well__---------Distance from foundation__-�--•_--__Distance to nearest lot line---- }� Number of lines--------------1-- --``-- _ Length of each line_��`�_�_�_�__.Width of trench---�--�-7.-------------- Type of filter material_�]erz.--___-_Depth of filter material____49_---_--------Total length______l_____ ------------------------- Seepage ___________--______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_-__________________------_ ____.. F1Size; Diameter------ ---•------ ------Depth-------.---------------------------------------------Liquid Capacity-------:---------------- gals. Privy: Distance from nearest well------------------____-------___---___.__--_---_Distance from nearest building__________-_--__________________--_____. ❑ Distance to nearest lot line-------------------- ---------------------------------------------------------------------------------- Remodeling and/or repairing describe)----------------------------- --------------------------------------------------------------------------------------------------------- -------------------------------------------------------- --- ----- ------ --- ------ -=------------------------------------------------------------------------------------------------------------------------ f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and r a ion of the San Joaquin Local Health District. (SI _ � �-� ��----------- - '-------- -- r: {Owner and/or Contractor -----•---------------------------------------------------------------------------- - (Title)le)-------------------------------------------------------------- f (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY -------;"7--------------------I----------------- DATE-----------------------------------------------------------. " . DATE-"--- -----�-�----�--�----" - --'-`--- ---- � REVIEWED BY-------------------------------- s1 � � ----- BUILDING PERMIT ISSUED-------- ----------- - DATE -- �- 1 Alterations and/or recommendations:-------------------------------- ------------------ ----------------------•------------------- ----------------------------------------- ------ ----------------------------------- -------------------------------------•-----------•-------------•------------ ---------------------------------------------------------------------------------------------- -------- ---------------------------------------------- ---------------------------------- N---------------------------- I - ------------------------------------------------- , 04 ,� . ` BY - - � / - s '�.0� Date-------------------------------------------------------- FINAL INSPECTION f SAN JOAQUIN LOCAL HEALTH DISTRICT a 130 South American Street 300 West Oak street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California � � i ` ES-9-2M B-51 Revised W-2100 _