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*� ! APPLICATION FOR SANITATION PERMIT Permit Noc::.!P__rZ_.. (Complete in Duplicate) Date Issued Application is hereby made fo the San Joaquin Local Health District for a permit to construct struct and install the work h This application is made in coml pliance with County Ordinance No. 549. erem described. SII`m .__ - �~ JOB ADDRESS AND LOCATION____1e ___--_ Owner's Nae p i � P -- Phone -------------------- --•-•--- Address. -�-....&3--- ----- --- ----- Contractor's ---- Name--- rr..__ __ Phone_-------__ --- r -- Installation will serve: Residele ❑ Apartment House [] Commercial-O� Trailer Court ❑ Motel ❑ Other s '� Number of living units: !'_-__,_ Number of bedrooms -------- Number of baths -------- Lot size Water Supply: Public"system❑ Community system ❑ Private Depth to Water Table ft. yp Character of soil to a depth of 3 feet: Sand,Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes El No ;-Naw Construction: Yes El No kr- 1[. '~ TYPE,',OF INSTALLATION AN© SPECIFICATIONS: 1� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Tank: Distance from nearest well-----------------Distance from foundation___________________Material______.._________._._.__._------------------------------------- -- -------- No. of cornpartmerits--------------------------Size...--- -----Liquid depth-------------------------.Capacity------- Ijli - + - � disposal Field: Distance from nearest well- � Distance from foundation__-- _-aDistance to nearest lot line_--�_a>-- Number of illi ines------------ Length of each line------ __Q0-------------Width of trench...... Type ar filter material- - _Depth of filter material---.- Total length__- Q-r.--__!_____-_-----__---- Seepage Pit: Distance toy nearest well.. -------Distance from foundation-----/�___ Distance to nearest lot line--- -r. Number ofpits_____ ------______---Lining material_L9t s, S- ize: Diameter__-___ Depth- I'll 1� - Z a - ----- Cesspool: Distance fm nearest well_________________Distance from foundation-----.------- ._._ Lining material--------------------._--____________- �1i ❑ Size: Diameqter--------------------------------------Depth-----------------------•--------------------- Liquid Capacity-----------------------------gal Privy: Distance from nearest well________-----------------------------------------Distance from nearest buildin ❑ in -. � -------------------------- Qistance toynearest lot line- ----------------------------------------------------------- --------------------------------'------------------------ --------- Remodeling and/or repairing [describe): �lf� � �f ��-2 •-------- ---------------- ' --------------------------------------- ------•---------•---------------------•------------------------------------•----------------------•-------------------•---------------•-------------------------------- 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 rulAh and regulations of the San Joaquin Local Health District. (Signed} / - -- -- ---- a'�r' �0 �p ......emw or Contractor) By:.... � -•------------------------------------------------------------------------------ F- -�.- - ------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �b hl a� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-i- ----------- - DATE REVIEWED .11 A ----------------• — BUILDING PERMIT ISSUED - K/------------------------------------- ------------------------------- - E-------------------------- ------------------------------- -• ------ - ----- - •---- - - --- ---------------------------------------- DATE---- ------ Altera+ions and/or recommendations-------------•-------------------- z` -•--•----------------------------------------------- ill - - 41 - ------------------------------------- - ------------------------- --------------------------------------I---------------------------------------------------- -----------------------------•------- FINAL INSPECTION BY: Date_ f li 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 ES-9-2M 10-52 Revised W-2100 i