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�,��"`�� '. APPLICATION FOR SANITATION PERMIT Permit No,(�67__9.________ (Complete..in Duplicate) / �� I z ,� Date Issued :- -1_ �(-/'f Applica4-ion is hereby made fo the San boaquin 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. I --------- Address , .. € . _ _. =JOB ADDRESS AND LOCATION ---- ------- ::r v tPhone Owner's Name-------------`----------- -- -:_: Address-------------_-• --- ----=-=- ---------------------------------------- --------------------------------------------------------------•------------• ------------ E - k�1 - ------------------- Phone------------------------------------ Contractors Name__--___ Installation will serve: Residence Aparfinen+ House ❑ Commercial ❑ Trailer Court•❑ Motel ❑ Other ❑ Number of living units: ---1---- Number of bedrooms ___�_-. Number of baths ________ Lot size _-__:____-50_�S__1--- _S________----------- Water Supply: -Public:system ommunify system ❑ Priva+e'❑ Depth to Water Table _--------'ft. Character of soil to'a depth of 3 feet: .Sand E] Gravel El Sandy Loam El Clay Loam ❑ Clay L] Adobe rdpan E] Previous Application Made: Yes ❑ No mew Con struction:,.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--------------L__Material----- '________._. h ❑ No.hof compartments------------------------'Size-------------'--------- - ---Liquid depth-------------------------`Capacity----•------------------ Disposal Field: Di0ante from nearest well________________ Distance from foundation----------------------Distance to nearest lot line____._________.__ ❑ Number of lines-----x---------------------------=Length of each-line--------.---------------_---_-Width of trench----------------------------------- Type of filter material-----------------_---____Depth of filter material-------------_,.,. -----Total length---...._.___,_-____________-_-_-_-_____ : Number' of its.-_-r'_-_---------- Lining materia_.-o______a+-._Size:µ' . p g I Distance to nearest lot line_____-___.__.__ Seepage Pit: Qistance�to�pnearest;well-_- ______.�___. _i Distance from foundatio�Qiameter_____________ ________Dept'n_.___..---__..__---__________-__ Cesspool: Distance from nearest welL__ blv'e_Qistance from fou dation f Lining mate rial_ �� e� -,Size: Diameter-- Depth =-^ --- - --Liquid Capacity-" 0©- --'y---gals. =-� a Privy. Distance'from nearest'well___ - ____.." _.__._D,istance from nearest building_________________________________________ ❑ •T _ - w -�- ------------ -------------- -TAT..__________--____.___.._- Distance to nearest lot line:- = ----------------------------- - " • ''= ..m Remodeling and/or repairing (describe):--------- ------------ ` w____ __________ = ----------------•• - . 0 ------------------------------------•-;-=------------- - = �,�.d, 1 r-----:_::_--------------- --------- _________ - - •-----------------------------------------------•----- -----------.-------.------•------------------------------------- I hereby-certify-+hat l have prepared this.application and fhat the work will be done in accordance-with San Joaquin County ordinances, State'.laws.and rules and regulations of the San Joaquin Local Health District. (Signed) i_ _]..- -_t�� Y_Yi1t -_.__-_-- �-------- ------ Owner and/or Contractor `� / 1 Title (Plot plan, showings ze of lot, location of system in rely o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----------------------------------'L------s---------------------------------------------- DATE----------------- REVIEWED - -- ----•--.--REVIEWED BY �- -------------------- ------ DATE--------- ------------- - BUILDING PERMIT ISSUED---=------------------ ----------------------- `_ .. DATE ------------ ------------------- ---------------------- Alterations and/or recommendations:-..-_�-----------------------------`-- --- -------------------------------------------------------------------------- ----------------------------•-••---------•-------------------------------------------------_-------•---•------ � ---•-•-------•--•-----------.--------------------------•-•---------------•----------------•-•-----•--•--r- ---_.-_-_•.-_- ___________________________________________________________________________________________________________._.______.____.___________----____---_____________..._______.______________.._____.____.___-____-___---_---_ I1. --------------------------------- -----------------------------------•----------------------- - ---- -------------------------------------------------- ----------------- FINAL- INSPECTION-BY:-w�r-_�--�-=---------- -------t------------- ----------- 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 E5-9-2M : - Revised W-2100