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M APPLICATION FOR SANITATION PERMIT. Permit No.,;?/A,4----- (Complete in Duplicate) " _.. Date Issued 11_1_"_•S 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__________------- ___6- --------•___ � -------------------------------------------------------------------------- Owner's Name. Z.1_ pfC_ .. - -------------- Phone--- 7 t�� Address---------------- •- -------•-•----------------------------------------•------------------------------------------------------ Contractor's Named_ ----------------------------------- --------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other t,C"4' j Number of living units: --%S4_ Number of bedrooms _6--- Number of baths -_X: Lot size ®C�_---_- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _______ ft. Character of soil to a depth ofw3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sepfic.Tnk:� Distance from nearest well-----------------Msfance from foundation_---.-_____--____.Material _____________ - No, of compartments--------------------------Size----•---------------------------Liquid depth----•---------------------Capacity--- Disposal Field: Distance from nearest well------------------Distance from foundation---------_ _Distance to nearest lot line_________________ Number oflines------------- r-/-----if.__-- Length of each line______'- -----------Width of french____.c�__ _'`---------------I Type of filter ma terial_/_K-`3'__42 k__Depfh of filter material____LR'____--_-_.--Total length___-___�?` ___ _______________Seepage Pit: Distance to nearesf well______________________Distance from foundation________-____-_____.Distance to nearest lot line__-_-______Number of pits-- Lining material-----------------------Size: Diameter------------- ---------.Depth-------- Cesspool: Distance from nearest well__ r0_____Distance from foundation____---1-Q- .-.Lining material_--�_ YJ-___-Size: Diameter----- Depth--- --------- '---------------------------- Privy: Distance from nearesf well------- _Distance from nearest buildin -� r9 ------------------- Distance to nearest lot line____----___- -Q 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) ----------------------------- 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 -1' ------------- ---------------------------------------- DATE------------ --- - �--------------- JEW EVIEW ED BY----------------------------------------------------------------- ------------------------------------------- ---------------- DATE-------- ------- ----------------------------------------- BUILDING PERMIT ISSUED----- -------------------- DATE----_------_---------------- - -- - _ ----------------------------------------------------------------------------- Alterations and/or recomm atien --------- ------ ------------- ------- ---- ---- ---- --- ------- ----------------------------------------------- ------------------------------------------------- - ------------------------- ---------------------------------- FINAL INSPECTION BY:------------T_!✓ - / -------------------------- VDate----------------X �.f ---- 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 8.51 Revised W-2100