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: . APPLICATION FOR SANITATION PERMIT Permit No. ..r `. II (Complete in Duplicate) Date Issuedll�_t---- 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 �-ompliancewith�County Ordinance No. 549. IIII Q JOB ADDRESS AND LOCATION..__ _,e! _F ___._ `__ .. Owner's Name-------------------- I� • • /Y. -/ (a -- --- --- Phone------------------------ Addressd�N ' ' �� Contractor's Name----------------------- ---- -- - ----• _..�.------------ Phone �t `j� D Installation will serve: Residence D< Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of living units: __-/-- Number of bedrooms .3-_ Number of baths -__ Lot size ____1a-_ _ ', _' -—'___________________ Water Supply: Public syst9l� El Community system ElPrivateR Depth to Water Table -------- ft. Character of soil to a depthgg of 3 feet: Sand ❑ Gravel E] Sandy Loam ID Clay Loam E] Clay E] Adobe ❑ Hardpan E]Previous Application Made:i1 Yes ❑ No P!� New Construction: Yes K No ❑ TYPE OF INSTALLATION SAND SPECIFICATIONS: (No septic tank or cgNsspool permitted if public sewer is available within 200 feet.) II s Septic Tank: Distance from nearest well_74�---.__Distance from foundation_/&*-_______.Material___L-__ No. of compartments__11_---------- 'Size _ __X_ _ __Liquid depth__Z-7r=_`�._.____._Capacity._900__�`- Disposal Flefd: Distance from nearest well._9.5�__ _Distance rom �ou dation----Zj0__*'___.Disfance to nearest lot line___.,$'"-____. ,I1 Numbe=��of lines------ - _ rr___ ________Length of each line_____�__�t.-_----------Width of trench...... -4Z . ", Type os filter material--(--,% jk---Depth of filter material-------/_ ___Total length---------1__�_---------------- Seepage Pit: Distanc 11 to nearest well------------- --------Distance from foundation-------------------.Distance to nearest lot line----------------- ❑ Number. of pits--- ---- -------------Lining material-----------------------Size: Diameter---------------- ---Depth--------- ----------------------- Cesspool: Distant from nearest well-----------------Distance from foundation__.-----------------Lining material---------------------------.--------- Siz ❑ _ e: Diameter---------------,.. _ ---------Depth----- .- , - C.apaci.ty.......... . Privy: Distance from nearest well..._---------------------------------------------Distance from nearest building____._____.__._______________-______._ ❑ Distance to nearest lot line--------------------------------------------- ---------------•---------------------------------------------------- ------------------------- I Remodelingand/or repairing (describe):----------------------------------------------•---------------------------------------------------------------------------------------------------•---- ` ---- �� ------------------------------------------------------------------------------------------------------------------- ----- ---------------._-•-- ---------- ----------------------------- ------------------------------------------------------•-•-----------------•--------------•--------------------------------------------------- - - 0-------------------------------------------------•---------•-•------------------------f---•----------------•---------------------------------------------------------------- I hereby c r+ify at I have prepafe"d this applica ion and that +he work wll be done in accordance with San Joaquin County ordinances, S+ a laws,=andl;rul aJ� reulations of t e S n Joaquin Loc I, ealth District. (Signed) Cl.� d � ---- ---------- - n Contractor --- By:----------------------------��1------------------------------------------- --- --- --- ------------------------ -----------Ta+le �� (Plot plan, showing size of lot, location of system in r I ion to wells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED`!` BY----------------------------------- ---------------- --- DATE------- --/ �— REVIEWED BY 11l= f .�� ------------- DATE--------------�--------�----- ------�---------- BUILDINGPERMIT ISSUEDi'--------------------------------------------------------------------------------------------------- DATE----_.-------------------- ---------------------------------•- 11 Alterationsand/or recommendations--------------- ------- ---------------------- ------------------------- -------------------------------------------------------------------------------------- :11 Ij` -------------------------------- ---------------------------------------------'Ib------------------- ------------------------------------------------- ----- --------------------------------I-------1[--- -------------------------------------------------------- •-------------------------------------------- ------------------------------- ------------------ ------------- FINAL INSPECTION BY ' Date ----------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street, 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California i Lodi, California Manteca, California Tracy, California ES-9---2M 10-52 Revised W-2,00 III'