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APPLICATION -FOR SANITATION PERMIT P - ,t No.-k4_I (Complete in Duplicate) e Date Issued ----- ------ ------ Application is hereby made to the San Joaquin Local Heaith 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 LOC TION.-.-.---- --------- ---------t, -- -------•--- ------------•--- ------•-------------------------------- - ---- Owner's Name------------- Address---- -----------Address----------------- - �" - --------------------------------••-----------------------------------•------------------------------------ Contractor's Name------------------------------------------------------------------- -------- ------------ Phone--. ----------------------------------------------- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I---- Number of bedrooms , Number of baths I----- Lot size - x --- -11 --- ---------------------------------- Water Supply* Public system RIO Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe Hardpan ❑ 'k Previous Application Made: Yes ❑ No �ew Construction: Yes W"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_,-Distance from foundation--------------------MaferiaL- "A=!=f - f "'- ---Capacity-- ------ No. of compartments-------�--------------Size , Liquid depth-----,?- Disposal Field: Distance from nearest well 7u''-—Distance from foundation-'�"0? ! 'Distance to nearest Igt Iine%S-rO Number of lines------- --=---------------------Length of-each line----J "-�-"-----.Width of trench____--�--- ----------____--- Type of filter material_e- ----------Depth of filter material-_-� -------------Total length_____ 's_� _- ------------- Seepage Pit: Distance to nearest well--- fro foundation_sl~--_-----------i Vance to nearest lot line-4 r� ------------ Number r! of pits------I--------------Lining material-- ---- --- -----------Size: Diameter__---------------- ---.Depth_-�, ----------------__-_-- 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 ❑ Distance to nearest lot line------------------------------------------------------ Remodeling and/or repairing (describe)------------------------- -- f ----------•-------- --------------------•----...-...------------•--------------•------------------ -------------------------------•---------------------------------------------------------------------- --------------•-------------------------•-----------:-----•-------------------------------------•--------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that +he work will 6e done in accordance with San Joaquin County ordinances, Sfate laws, and rules and regulations of the.San Joaquin Local Health District. {Si ned E g } • �___ ----------------------------------------------------------------------------------(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--------- DATE REVIEWED BY � ff/ - �x DATE _ .� _ '`-- '77/----------------------- ' f "`r�� : ---------------------------------- BUILDING PERMIT ISSUED - ------------------------ -------- DATE---l--�-- ---------------------------------Alterations and/or recommendations----------------------------------- -------------------•---------------------------------- ----- ----------- ---------- + ------------------------------------------------------------------------------------ ------ ------------•----------------------------------------------------------------------------- -------------- ------- --------------------------------------------- ---------------------------------------------------------- --- - ----- ------------------------- ------------- --- - - FINAL INSPECTION BY: Date ' - ------------------------------- i 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 }