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he PLICATION FOR SANITATION ON PERMIT Permit No. _�,__ti.-a`��-,--- ►' (Complete in Duplicate) >, _ [3ate Issued Application is hereby made fo the Sa Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance 549. J08 ADDRESS AND LOCATIOewl -----,-r.�E, e�-�� - - Owner's Name--- -- -------------------------------- -- -------- ------------- __. PhoneLZ- ,. `r�- � Address----- --- ------ - ------------ - ---- ---------------------------------------------------------------------------------------------------------••- Gontractor's Name_____________________ -- -•- - ---y------;, - ------- Phone__ Installation will serve: Residence Apartment House ❑ Commercial [I Trailer Court er Number of living units: __/- --. Number of bedrooms { ❑ Motel ❑ Other ❑ --- Number of baths -_� Lot size __---- Q_��44 Water Supply: Public system Y� uy ❑ Community system ❑ Private Depth to Water TableZQft• Character of soil to a depth of 3 feel: Sand ❑ Gravel ❑ Sandy-Loam E] Clay Loam [j -Clay ElAdob� Hardpan El Previous Application Made: Yes ❑ Nom` 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 nearest well_. Q----Distance from UuafiPn_ --�-- ---- .MaterNo. of compartments----- Si . �, __Li uid de th_ '. r q p 3 Capacity----- � Disposal Field: Distance from nearest well_-yam?�-, -.__ -._Distance from faundation� ___"__-__. �' � Number of lines-------.__/____ - --� Distance to nearest lot line_____ ____ _ -------- Length of each line________' g Width of trench -------.--- T e of titer material it Type r Depth of filter material_./J_ Total length_--.- ---------------------------- Seepage Pit: - -Distance to nearest well--------------------_Distance from foundation-------------.------Distance to nearest lot line_.-__-_-_____--- r ❑ Number of pifs----•-----------------Lining material-----------------------Size: Diameter_--------- ----- --- ---Depth--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation______ _______Lining material.____-._______----------------------- ------------------------------------------El SiZe: DIanlEaer------------------------------------Dept h----------- Liquid Capacity- --------------------------gals. Privy: Distance from nearest well Liquid ____ --Distance from nearest building istance to nearesf. lot line------------------" g , ------------------ 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, rules a r guiations he San Joaquin Local Health District. (Signed)------ ----- ------ .. --- ------ --------------------------------- ------------------ ------------- -----------(Owner and/or Contractor) BY= -- A---------- [Title �'(Plot plan, showing size , ocatio of system in relation to wells, buildings, etc., can be F don reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____-._---_ - - --------------- ----------------------- ----- DATE- ------�---��----J� REVIEWED BY---------------- - --------- - ---------- -------- �-�--------------------------- -- - ---------------------------- --------- DATE- ------- ------ ----------- -- •- BUILDING PERMIT ISSUED______________ - -------------------- ------------------------------ DATE- ---- ----------------- Alterations and/or recommendations:______-__-______---." -- ---- ------- ---- -------------------------------------- - -•• -------------------------------------- --------------------------------------------- ---------------------------- FINAL -- -------------------- FINAL INSPECTION BY:------------ - ---. - -- ---- ------------- ---- -------- Date- -------- - ------ ��- ---�---------------------- -------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California 814 North "C" Street ti Manteca, California s Tracy, California k --9-2M I0.52 Revised W-2100