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/G -��-sem APPLICATION FOR SANITATION PERMIT //Permit No. i (Complete in Duplicate) Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to c truct and install the work herein described, E This application is made in compliance with County Ordinance No. 549. I JOB ADDRESS ANp OCATI Owner's Name_-__._ - Phone_,�t'c•-r." Address------------- -----• - ; ------•--------------------- -- - ---- -- - - - - - - ------- Contractor's Name------------------- -•- ___ ----------____-- Phone__ ---------- ----------------------------------- Installation will serve: Residence Apartment House [] Commercial (] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _" Number of bedrooms Z- Number of baths _--/--- Lot size __ „1��J_ Q (7 - -------------- Water Supply: Public system Community system ❑ Private E] Depth to Water Tablet} ft. Character of soil to a depth of 3.feet: S Ind ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑' Adob 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.) Septic Tank: Distance from neares0welll Ego _ _Distance from f�undati n____ �,1 - �---------.Material-- - =--- -.��'� - -----No. of compartments-- _ -__-.___--Size-� � 7�-?iquid depth_ ----� _ ___-!_Ca acit p Y Dis os I Field. Distance from nearest ;well --___".Distance from foundation--- _ . ____ _________Distance to nearest lot line_-__-__�____.. Number of lines-----------'i__-I----------------Length of each line---------------/4--------Width of trench---------------------___-- - -_--- Type of filter material'------------------_---Depth of filter material-----------------------Total length----------/4�--"--------------------- Seepage ---See age Pit: Distance to nearest well ` .S7 +�. -'Distance f om fo dation_____ _i_______.Distance to nearest lot line- Number Number of pits-------- --'--------Linin materiae 9 Size: Diameter--- ---------,-----Depth-- Q�-Q---- .-•. Cesspool: Distance from nearest;well--------------- Distance from foundation--------------------Lining material----------------------.- aG ��-• ❑ Size: Diameter -----------------------Depth---------------=-= = Liquid Capacity gals.(� Privy: Distance from nearest welt ---- - Distance from nearest buildin ❑ Distance to nearest lot;line--- "--- __ g -----------------'--------"-- -----------. Remodeling and/or repairing (describe):___:I__ __ ____ __•_ -------------------------•-------------------------------------------•-----------------------------"---------- (p } ----•--------- ------------------------- �-+ --------------------•----------------------------------------------;--------"--------------------------------------------------------•----------------- ----------------------•--------------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County f' ordinances, State s, and les-,and regulations of the San Joaquin Local Health District. (Signed) -- � t --------------------- - (Owner.and/or Co t actor) By:--•------------------- � Tale ------------------------------------------------------------ - (Plot plan, showing size lot, Iocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY =------- DATE-- ----------- REVIEWED BYf --- --------------- ----------- ------------ ----------- DATE---- ------------BUILDING ---'----------------------•-----------•--- PERMIT ISSUED ------ ---------- DATE ------------------------------------------------------ Alterations and/or recommendations:_______.-- ------------------------------------ ---------------------------------------------- ___-_____-__-______________P___-_ _ _--_______ _____________„_---.__------___ FINAL INSPECTION BY------------ - - Date__---- "-- - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California L5-9-2M 8-51 Revised W-2100 F