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low APPLICATION FOR SANITATION PERMIT Permit No. S_______ (Complete in Duplicate) 1�` 1 Date Issued 1______-_r�.____�_. Application is hereby made to fhe 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. /IjE- JOB ADDRESS AND --- _..- - ----- --� -- - --------- ;TIQ - -- ----- - - --- Owner's Name------ - }-- ----ti----- ----------••---------•-----•------------------- -----------V-------------- -------------- Phone-------------------------- - ------ Address---�Q4---- ..T... �R? --------- n/} Contractor`s Name............. ••-• --••--------•------------ -------------------------- -------------------------------------------- Phone----•---------( �, Installation will serve: Residence ❑ Apa ment House ❑ Commercial ❑ Trailer Court ❑ Mot el ❑ Other Number of living units: _Q_ Number of bedrooms __O.. Number of baths ._0___ Lot size Water Supply: Public system [:1Community system E] Private, Depth to Water Table____j ft. Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[ Hardpan ❑ Previous Application Made: Yes ❑ No A 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.Q0_Distanc�efrom found Pion----/L7-._____-Material----- No. of compartments.-----'1/--------------Size-----.7" _ x_r _--Liquid depth-------- -----------Capacity__-_R_6__0---- Disposal Field: Distance from nearest well...[QQ_f --tistance from foundation-----I_-5�--_._.Distance to nearest lot line- Number of lines-------------!_______ Length of each line-______ _b.- f/._.Width of trench______ __ Type of filter materiaL_S p length th of filter material len th__-._-•------_---2--a............... Seepage Pit: Distance to nearest well__--------------------Distance from foundation--------------------Distance to nearest lot line__.____.______.__ ❑ Number of pits----------------------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 nearesr building------------------------------- ^ ❑ Distance to nearest lot linne -- ----------------------------------------------------------------------------•------- ----------------------- 12 Q Remodelin nd/or repairing (descri e):--- �,f� �-- -- ------ - --- �--- x.- - - -------------------------------- -------- •-----•---------- ----------------------------------------------------------•--- ---------•----------------------------------•-------•--------------------------------------------------------------------- ------------------------- . 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, .and rules and regulationsof the San Joaquin Local Health District. ct&, -------------- -—- ---------------- -�--------��-�'-c-e�-`----------------------------------------------- (Owner and/or Contractor) (Signed) BY=`------------------------------------ -----------' ---------------(Title)------------------------------------------------------ (Plot plan, showing siie 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----------------------------------------------------------------- - ------�------------------- - ---- - DATE.--------- --- ---------- - BUILDING PERMIT ISSUED----------------------------------------------- - ------------------------------------ DATE----- -------------------- ------------------- -------------- Alterations and/or recommendations------------------------------ ---------------------------------------------------------------------------------•---------------------------------------- ------------------------------------ -----------------•----------------------------------------------------------------------------------- ---------------------- ------•--------------------------------•------------- --- -------------- ----- -- ---- - - ----------------------------------- -------------------------------------------------------------------- - _ q FINAL INSPECTION BY: -----� — -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100