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___. APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) S� Date Issued Applicati is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap cation is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----.r --W-3-'2�� -----! ----------- ------------------------------------------------------------- ------ 47p Owner's Name-----------------/ll l- ---- -- •`-----I--------✓ �; ------- Phone_ �} Address--------------------------------- -----------� ----------� �=------- -- -- ---------`-------------------------------------------------------- Contractor's Name----------------------- ---- -------- ------------------------------------------------------------------------------------ Phone------------------ ------ Installation will serve: Residencepar+ment House ❑ Commercial ❑ Trailer Court [-I Motel E] Other L] Number of living units: _____ Number of bedrooms _ _dumber of baths -_ ___ Lot size _ ,______ + _� __r__________________________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ar pan ❑ Previous Application Made: Yes ❑ Noew Construction: Yes 9-11-010 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well___&�K'C Distance from foundation___/f -�_____-Material____ __ __ _ _ _ ___ ____ __.-. No. of compartments----- -1— Size_�K__ Liquid depth------- ------------Capacity------� Disposal Field: Distance from nearest well-_�� '13istance from foundation____ ��--_Distance to nearest lot line--- Number ' Number of lines---------- of each line-_-- -- __ _ _t____-.Width of trench_____________ 7 - Type of filter material of filter material_______ __ ______-Total length_______ -,=i Seepage Pit: Distance to nearest well_____________________Distance from foundation--------------------Distance to nearest lot lin -_--_____________ ❑ 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 6is4ance to well--,--__-------;--_ raihu -- ----------------"""- ---- -----r- t neareof ine- - --------------------------- -------------------- ---------------------------------- •- -------------•-•------------- ----- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- { ---------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ hereby certify t i have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la nd r: es aid regulations of the San Joaquin Local Health District. (Signed)------- ---- --- .--- -- -- ----------------------=--------- -- ---- --------------- ------------------------------------------- ------(Owner and/or Contractor) Sy=----------------------------- ------------------------------- ----------------------- ---------------------------------------(Title)---------------------------------------------------------------- [Piot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --- ----.--- - ---------------------------------------- DATE--- --��.. REVIEWEDBY---------------------------------------------------- ------------------------------------------------------------------ . DATE----------------------------------------------••---- ------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or re�]c"ommennddations-------------------------------------------------------------------------�--- ---- ------------------------------ j-�----�-p-t--------------------------------------------- j -------------------------------------------- ^- ---- i -----------------------------------`---------------------------------•--------------------------------------- ------------------------------------------------------ ---------------------------------------------------- 1i------------------------------------ FINAL INSPECTION BY____ _____ _ ___ _ Date------ -- ----- --- -----------------•--------------------- I 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 ! ES-9-2M 8-51 Revised W-2100