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I 1q,11 111111 APPLICATION FOR .SANITATION PERMIT Permit Ng;.,/ (Complete in Duplicate) . $ m 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 JOB ADDRESS AND LOC—ATIO �� ----------------- x Owner's Name_____C,l,____!,___._ -----------------•-------- -• --------•- -- p ------- ------------ ------ ------ - ----------- - Phone__�--s�4�_`.3---- --- Address------9 ± �- Contractor's Name-._ Installation will serve: Residence 19 Apartment House ❑` Commercial E] Trailer Court E] Motel ❑ Other F1Number of living units: 11-�_ Number of bedrooms _I-__ Number of baths!_--__ Lot size ---NT'-44-----X_1_3_4 Water Supply: Public system ❑ Community system ❑ Priva lox Depth totWater Table-Yh- ft. Character of soil to a depth of,:3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ "Adobe Hardpan ❑ p . Previous Application Made: Yes ❑ NoX New Construction: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se is available within 200 feet.) ii: Septic Tank: Distance fr ares well------- .__--_-Distance from foundation---_---------------Material------_-----_-.._---_._ -----•----------------- No. of c art ---------------Size--------------------------------Liquid depth---------------- ---------Capacity ------ Disposal Field: ist r{c nea well------------- from foundation--------------------Distance to nearest lot line___.___.__-____.15 ❑ er of l:li ---•------------------ -----------Length of each line------------ -------- Width of trench ------ e-of ' er material------------------ y-. -------Depth of filter material------ -------------Total length-------------- -�------------- ------- Seepage Pit: Distance to+lnearest well-----f 4- .------Distance from foundation---41d._..___.Distance to nearest lot line--_._"�.�-. Number of pits-------- material-S!_. �-1 Size: Diameter____._. ---____J. 3 e6 ---- Depth------- -------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material_.--._----_-__-_--.--._:-_-----_-_ ------------------Depth----------------------------------------•----------Liquid Capacity-------- ------- gals. 1 ❑ Size: Diameter--------- ------=-- Privy: Distance from nearest well__________ __________------- Distance from nearesr building ------------ El Distance to'nearest lot line_____________________________ Remodeling and/or repairing (describe):------------------------------------- _ •-------••---------------•----_-_--•-------- ------------------- -----------•------------------------------ ------- -----------------------------------•--------------------- ------------------------- ----------------------------- I ��. hereby certify that I have prepared this application and that the work will be done in accordance with4San Joaquin County, ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------- - ------------------- ------- ---------------------------------------------------------- -------I wner and/or Contractor) . By:---------------------------------�.�t.,+ .Qa-----W_ - --- _ Title ( } �i../--------- --- (Plot plan, showing size of lot, location of system in r anon to wells, buildings, etc:; can be placed on reverse side). i F R DEPARTM USE ONLY APPLICATION ACCEPTED BYJ--------------- ----------- D' ATE------- - -- - ---- - ---#-------- -- ---- --�-- ---- --------------- REVIEWED BY------------------------- ''-------------- -------------------------- ---- --------------- - DATE - -------------- ----------------------- BUILDING PERMIT ISSUED.______:)__._..___-_ --------------------------------------------------------------------------- �- ._ DATE---------------------•--------------- Alterations and/or recommendations---------------------------------- --------------------------------------- -•---------------------------- ------•-------------------- ------------------------='------ - ---------------- ----------------- - ---------`--------------------------------------------------- ----------------------------------------------------------- -- -------------• ------- .---- ----- ------- --------- ----------- FINAL INSPECTION BY: ---- - -- r _e_1____._------- Date-------- ------- - 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 E ES-9-21M 10-52 Revised W-2100 i' +