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//... .. APPLICATION FOR SANITATION PERMIT Permit No. T' (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. JOB ADDRESS Q LOCATION_ Phone----------- ------------------•----- ___ ____. - - a ---- Owner's Name- --_---- -- ' ------------------- Phone---------------------------------- Contractor's Name_____________________ ---- ---- --- -- -- Installation will serve: Resiclence;E�. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living uni}s_ -- ---- Number of bedrooms Z�mber of bat s -1 Lot size .------e'7,4_x-- ----- ---- ------------ Publicsy stem [I Community system ❑ Private epth to Water Table -------- ft. Water Supply Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam [I Clay El Adobe®—�dpan El Previous Application Made: Yes ❑ No New Construction: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) D - �� Maters ---------------------- Septic Tank: . Distance from nearest well-----------------Distance fro foun No. of compartments----_ -- ---Size-____ __ -�` - _---Liquid dept( --------- Capacity Disposal Field: Distance from nearest well. `"5�-..Distance from foundation-- ------ Distance to nearest lot lin _-- _-_ -------Length of each line----�-- -------------Width of tre __ P------- -------- Number of lines--------- -- + Depth of filter material-----/,¢f----------Total length-------- ---- --f------------------- Type of filter material -E. _�------ $ Seepage Pit. Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line----------------- --------Diameter De Depth -------- ----- ❑ Number of pits--- ------------------Lining material--------------- ------ p rr __ llv #. Cesspool: . Distance from nearest well_-_-------------Distance from foundation---------------------�inui.d Capacity �r gals. ❑ Size: Diameter-------------------------------------Depth_--------------------- ------ ---------------=----- q p Y--------------------------- Distance from nearest well-------------------- ------Distance from nearest building-------- -------------------------- -- Privy: ------- -- --- _ ❑ -------------------- Distance to nearest lot line---------------- -- -----------------------•------- --------- Remodeling and/or repairing (describe):---_-.-__ ----------------------------------------•-------------- -----------------------------------•-------------•---------------------------------- -------------------------------- - ----------- ---•---------------------------------------------------------------.------------•--------------------------•-------------------------------------- I hereby cerci that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta . la s, and rules and regulations of the San Joaquin Local Health District. (Signed]--- - - ---- -------- ------------ -- - -- ----- -- ------- ---- - -----------------(Owner and/or Contractor) 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 APPLICATION ACCEPTED BY -- r--- ------- ---- ---- DATE I -------- ------------------ ----------------••----------.. REVIEWED BY-------------------------------- - -------- ------------------------------------------------------------------------------ DATE BUILDINGPERMITISSUED------------------------------------------------------------------------------------- Al+eratians and/or recommenda+ions----------------------------------- ----- ------------------ ------•------•---- ------------------• --•------------------------------------ ---------- ------ ----------------•------------------------------------- --------•------------- ----- -- -----------I--------- - FINAL INSPECTION BY----------- ------------------------------------------------ Date ----------------- C --- 3----- - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street [30 South American Street 300 West Oak Street y Tree California Stockton, California Lodi, California Manteca, California y. ES-9-2M 10-52—Revised W-2100 .