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�'� .__ APPLICATION FOR SANITATION PERMIT Permit No. . �� ---�� (Complete in Duplicate) Date Issued _ r___` __1__--v Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei ribed. This application is made in compliant with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ ____________ o� , Owner's Name --y�� Phone Address--------------- r r � Q7 ... - Contractor's -Name-------------- __ Phone Installation will serve: Residence A4tment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑. # l d_ _1,. c�-------------------------- Number of living units: ___ _ Number of bedrooms ____ Number of baths __._____ Lot size ____- __ Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam-❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 9- New Construction: Yesx 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____:S�5----Distance from foun tion_ -__1A__--____-Materi --------dl,---- ------ Liquid - -- ------ 2144 ----- No. of compartments--------`�---------�ze-- - Li uid de th_:_______-- Ca acit + -- Disposal Field: Distance from nearest we _____ Distance from foundation__,__ _ ::`.-Distanee''.to nearest lot li�_ N Number of lines____>____--__-- -'_______________ ength of each line__ t��-f�--Width of trench.__._ Type or filter material_S -��°,&epth of filter material___-____ - 9 ------------------ --- Total len th �Q- --------------------- 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------------___-_-_____-____- F ❑ _ ._ Size: Diameter. -.--_• ��,er`�.th �c;;��Li�uidVCapacitY - - -._gals.��;r Privy: Distance from nearest well-------------------------------------------------Distance from•nearest building------------------------------------------ ❑ Distance to nearest'lot line------------------------------------------------•---------------------------- --------------------------------------------------------- ----- repairi ------ - -tf ------ '---' G r ---------'-------------------- Remodeling and/or ng descrii�e}__________ ___ y ----------------------------------------------------------------- -- - ----- -- I hereby certify +hat 'I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta �a . and ruWandegul .'ons the Sani:oa uELocal Health District. _ - ' {Owner and/or Contractor] ----- (Signed) ---- --- -- -- --- 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 REVIEWED BY---------------------------------------------E D BY----- ------- ------------------------ ----- _------------------------------------ DATE--------------- --------------f--------- ------- APPLICATION ACCEPTS 4 •- DATE-----------I A .4 � �------- -------- ----- io BUILDING PERMIT ISSUED------------------------- ----------- ------------------------- DATE------------ --- --------------------- ----- Alterations and/or recommen'datians------------- Aea_ ------•----------------------------------------------------- ---- - :-- ---- J FINAL INSPECTION BY--------------- ----------- ---- -- ---- -------------------------•---- 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 E5-9-21A 10-52 Revised W-2100