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s o. ------ -r---- APPLICATION FOR SANITATION PERMIT Permit N --------- (Complete in Duplicate) Date Issued Application 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. 7--- -----44------- -&- a-V6 --------- -------------------- JOB ADDRESS AND LOCATION �p____.--! Phone��`S` -------------- Address--------------- � 'x�` `T°— ------------- --------------------------------------- ------ Contractor's Name----------- x----•�----------A-��-I-''�-�--- -- --_�&�✓S.S.�------�1�� ---------- Phone ' Motel ❑ Other ❑ Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ ` f Number of living units: -------- Number of bedrooms _______ Number of baths -------- Lot size 1AY------ ----------'----------- � Depth to Water Table.,,�S I Water Supply: Public system V Community system ❑ Private ❑ p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I�Q Hardpan ❑ Previous Application Made: Yes ❑ No X 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_________________Distance from foundation--------------------Material----------------------------------- ❑ No. of compartments Size--------------------------------Liquid depth-- ----------------------Capacity-------- ----- ------ Disposal Field: Distance from nearest well----------------._Distance from foundation--------------------Distance to nearest lot line__________-____-_ Number of lines----•------------------------------Length of each line-----------------------------Width of trench----------------------------------- F1 T e'bf filter material-------------------------Depth of filter material----------------------Total length_------•--------------------------------- YP, Distance from foundation__._____._.__.Distance to nearest lot line-15----------- Distance ____-__ Seepage Pit: Distance to nearest well----��. ------- ,� - . �� Number of pits_- -- -----Lining material_i�of -R,.Size: Diameter _e-�lh--_.Depth__-3t2--------------------- --------------------- Cesspool: - ---- Cesspool: Distance from nearest well_______________ Distance from foundstion--------.----------.Lining material---._________..- gals. -----------Depth-------------------------------- ------Liquid Capacity---------------------------- ❑ Size: Diameter________-________ k t _____-.--___Distance from nearest buildin Privy: Distance from nearest well_ g --------------------------------------- Distance❑ to nearest lot line----- ---:--------- --------------- ------- - Remodeling and/or repairing (describe):---------�--1--b1_T!¢-tit-------------77------ f ` _/l! --------.. _ -.-------•-- ----------------- ------------------------- --------------------------------------------------------------------------------------------------------- - --- -------------•---------- ---------------------------------------------------------------- ------------------------------- ------__ ---------------------------------------------------------------------------------------------------------- I hereby certify that I have prepP4 this application and that the work will be done in accordance with San Joaquin County ordinances, S laws, and rules a r ulations��orrf the San Joaquin Local Health District. (Signed}` ..r_ a e 14__R,f __(_ __(�l -- - s /ll ---- . ---- . ------------(Owner and/or Contractor) By:--------------------- ----- ---- -f----------(Title] (Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be placed n reverse side). x FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY--e'?- -------- - ---------------------------- DATE__ ------------------------------------------ •�o - ---------------------- DATE-------- ----------------------------------- REVIEWED BY--------------------------------- - - f BUILDING PERMIT ISSUED------------------------------- -------------- -------------------------------------- DATE------------------ - ---------------------------------- ----------------------------------------------------------- Altera+ions and/or recommendations:--------------------- - --------- -------- --------- ---------------- -------•-------------------------- ---------------------------------------------- F1NAL INSPECTION BY:-----�----�-- 1"A—— ---------... Date-------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT } 300 West Oak Street 132 Sycamore Street 814 North "C" Street l30 South American Street Tracy. California Stockton, California Lodi, California Man+eta, California ES-9-2M 8-51 Revised W-2100