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APPLICATION FOR SANITATION PERMIT Permit No. -- _--.#q.__! (Complete in Duplicate) Date Issued --- Applica;-ion 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. 14)� JOB ADDRESS AND LOCATION---L- _ -- -l-- - - . O- ------------ ----------------------------------------- Owner's Name---- ---------- ----------------------------------------------------- Phone--- Address-.--4.01 Contractor's Name-•---- 0_wgJ%--------------------- - - Phone---ems -------------- Installation will serve: Res iden�e)21 Apartment House E] Commercial E] Trailer Court ❑ Motel 9 Other ElNumber of living units: _- --___ Number of bedrooms A____ Number of baths __/--- Lot size -------__- ,��__� - ------------------- Water Supply: Public system Community system ❑ Private [I Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [] Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ Previous Application Made: Yes ❑ NoX New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n 1� ? Gu00 Septic Tank: Distance from nearest well_�37^�._Distance rom foundation__�p-_______-_.Material--------------_--__----____---_ -----._---- �f No. of compartments---Z______------Size- - 11 - -- _ --Liquid depth------- ----------------Capacity___•--QQ Disposal Field: Distance from Weare t well_►'IAbrUL Distance from foundation--.___ -- r z c)___---.Distance to nearest lot line_.-3-_------__ Number of lines------- ------------------Len th of each hne_30 ,Sa / y] p --t ----- /1-;--._.Width of french -------------------- Seepage -------------•--- Type of filter material—LT A-.-De Depth of filter material--- �'---_----_Total length--------- ----------------------- ------ i----_---- J� ---------- Seepage Pit: Distance to nearest well----------------______Distance from --------Total Distance to nearest lot line----_--.---_--... ❑ Number of pits----------------------Lining material----_- .-- __..Size: Diameter-----------------------Depth--. ----------------------------- Cesspool: --------------------------- 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------------------------------ p ` ❑ 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. 1 [Signe � _ _-- -------------------------(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 --- ---/w------ -- --- --------------- DATE---Z- f = ------------- REVIEWED BY ----------- ------- --------------- ------ DATE - -------------- BUILDIN PERMIT ISSUED---------------------••--------------------- ------------ DATE ---------------------- Alterations and/or recommendations:--__---------------------- --- ------------------------------------------------------•----------•--------•----------------------•----------------------•-------- -------------------------•--------------------------------------------------------- --------------------------------------•-----• ------- •--------------------------------------•-------•-- ------------------ ------------ I / ) e, —---- ---- ---------------------------------*----------- I 1 FINAL INSPECTION BY:--- ---------------------- ------------- Date...- f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Stree+ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; RBVised W-2100