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e Nod c % APPLICATION FOR SANITATION PERMIT Permit NoA -`-3---- ti (Complete in Duplicate) Date Issued-_ f--'37Z n . 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 ad? in,compliance with County Ordinance W. 549. y �� /�`` •„ --- --------- --- i ,ter -------- - --- -�� JOB ADDRESS A D LOCA ION-n-- --- o ----- -- Address -- -- - Address----Q. --------- ----------------------- ----- ----- -------- -- Phone ------------- --''""{----------------------------------------------------- k Contrac#or's Name_"_ ____ ___ �.--- �. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M ❑ Other ❑ of living units: _�____" Number of bedrooms _ _ Number a maths __ Lot size ---- -------7, 3--- Number Water Supply: Public s ❑ em Community system '[I private Depth to Water Table -------- ft. system Hardpan El Character of soil to a depth of 3 feet: Sand [IGravel E] Sandy Loam Clay Loam ElCla y ❑ Adobe ❑ Previous Application Made: Yes ❑ No V New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o------Mater --------------------��j� Septic ank: Distance from nearest well___ --S."d c------ four #ion___;___ __ Capacity____"f - Size__ 7' oo No. of compartments--- ------- �--� -- ��------ -�-`-------Liquid de6th-------------- - - �� Distance to nearest lot line�__f___________- Dispos3l°Field: Distance from nearest we�ll_1jd_Q------.Distance from foundation`_- - Width of trench______ Number of lines____-____-- / .-Length of each line__- �1----. �} ---------- _ �[ :---- -- _-- e th of filter material--___-�_-j --_ ----Total length___"-- --�-�-E�'----------------- -- Type of filter material f > p Seepage Pit: Distance to nearest well______________________Distance from foundation_______________.___.Distance to nearest lot line----------------- ❑ Number of pits...................... ------ -------- ----Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cess ool: Distance from nearest well----------------- from foundation------------------- "L'snin Cat sial gals. Size: Diameter--------------------------------------De.pth--------------------------------------------------- q Capacity -----------Distance from nearest building----------------------------------------- ------------------------------------------------------Distance from nearest well-------------------------------- --------__----_ Distance to nearest lot line--------------------------------------------------------- --------- Remodeling and/or repairing (describe):----------------------- _ ----__--__---__ -•------------------ --------------------------------------------------- ty i hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin our ordinance Sta laws, and rules regulations of the San Joaquin Local Health District. {Owner and/or Contractor) Si red --------- ----------------- ---- ------ --------- ---------------- --------- --- ( 9 l ------------ -------------------------------------------- By----•----------- ---------------------------------•-------------- (T�t e ___-_- (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 DATEZ . -------------------- APPLICATION ACCEPTED BY-- - --------- - ---------------------------------------- ------------- ------- REVIEWED BY---------------------------- -------- --------- DATE__._.�--------------------------------------------- BUILDING PERMIT ISSUED--------------- ---- --------------- •- ---------------- -------- -------- DATE----------i --------------------------------------------------------I---------------------- - A---------l---t---e-------r-----a------t---i---o------n------s ---- --------- ------------------- Aiterations and/or recommendations______________________________----------.-------- -------------------------------------------------------------------------------------------------------- ----- --- ---------------------- --------------- ------------------------ F1NAL INSPECTION BY---- -------- ----------- ----------- -- Date------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lobi, California Manteca, California_,, y' ES-9-2M 8-51 Revised W-2100