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1:5� APPLICATION FOR SANITATION PERMIT 4 -.. � -� rmit No. (Complete in Duplicate) ► � Date Issued /Yj,5,3 ! A Thipplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT ---------- I ` -------------------- Owner's Name-------------------- - ----- -•-- - ------------- -------------------------------------------- Phone Address. ontractor's Name_________________________;Apartment ------- - -- --- - -•------ - --- ----------- ---- ---------------------- ------------- Phone Installation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ _ N er of bedrooms ---1--- Number of baths _ _ - r �___. Lot size Water Supply: Public system Community system ❑ Private p Depth to Water Table f#. Character of soil to a depth of 3 feet: Sand ravel E] Sandy Loam eOEJ yLoam ❑ ClayobePrevious Application Made: Yes El No New Construction: Yes [ � f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pub�li/c se is available within 200 feet.) Septic Tan Distance from nearest well-412,4 __- istance from foundation_______________Mate ial___ # -- L F� ----- No. of compartments-------------------- e___� y* , - Liquid dee th.Y---- , Disposal Fi Distance from nearest weI Distance from foundationzZ _____---.Distance to nearest lot line__S��___.___ Number of lines--- ___________e Length of each Iingj1Q - d W;dth of trench-_-. ___._-_---..-__--------_- Type or filter material ,r_ r p p - _ ----------- _,,,I-_ e th of filter material ----_-Total length_-,x,/11..______________ ------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.------Distance to nearest lot line-____________._. ❑ Number of pits---------- ------Lining material-----------------------Size: Diameter---------------- ------Depth---- --------------------- ------ it Cesspool: Distance from nearest well-----------------Distance from foundation-_.-------------- Lining material-__._______--_________._____.____. ❑ Size: Diameter--------- ---------------- ------ ----Depth----------------•------•----------------------- --Liquid Capacity gals. Distance from nearest well-------------------- ---- ------- ---- "- - Distance .f ror _ne test building------ _ Distance to nearest lot line------------------ _ - ----------------------------------- Remodeling and/or repairing (describe):-------------------- C - ........... ----- j--- ------ --- -------------------------•-•---------------------------------- ------•-----••---------- --------- ------ ---------•---- ------- •------------ -----•---- ------------ -------------------------------------------------------------------•--•----------------••------------•------------------------- ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , and rules and r lations of the San Joa in Local Health strict. (Signed)-- --'d----~ Q F" (Own and/ 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 77 APPLICATION ACCEPTED BY - _____ DATE--------- •-- -- - + REVIEWED BY DATE -------- teratiohs and/or recommendations:__ - BUILDING PERMIT ISSUED----------------------------- -------------------------------------- DATE--------•--------- -•------------------------------------- _____ ... -----------••-----------------------------------------•------••----------------•----------- --------------------------------•---------------------------- P 'sur a ------ e �._, -----_ �fi -- . �r -------------------------- - --------- -----•------------- ------------ ----------- FINAL INSPECTION BY:............ - IIIIIDate j---T------------------------------------------------------ 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