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jjjv y .APPLICATION -FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued ---9-7!,7"_s'___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 N� . No. 549. JOB ADDRESS ANDL (CATION---------126_4_41------- ___ ------- Owner's Name-------- - `-•-•-------- ------ - -- ---- --------------------------------------- Phone---------------------------------- Address ,„ .._.. ------- �. Contractor's Name_ - _-�-- - --•--__-••---- - --- ----- -- --- -----�,---_---�_W_ 5----------------------------------------- Phone-- ------r--- �� 7 Installation will serve: Residence �X_jApartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other E]Number of living units: __ ___ Number of bedrooms _�Xx Number of baths -_f L. Lot size _____' vx_ --------------------------- Wafer ---------------- -Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table_ ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2. Hardpan ❑ Previous Application Made: Yes ❑ No M New Construction: 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---J9`4_ Distance from foundation_____f4__r_--_-Materialf_ No. of compartments_______„ _____________Size___ ' -- - - __Liquid depth-------�_kf------------Capacity_____9Q`d - - f Disposal Field: Distance from nearest well_-._ d_-_-Distance from foundation____2�4__l------Distance to nearest lot line- -- in! Number of lines---- �;- --_-------Length of each line---------- ---4 _------.Width of trench----s �_ -_.--_______-_-•_-- Type or filter material----1�,_____"Depth of filter material___.__l -------Total length--------.7�___________________ --Seepage Pit: �- .__Distance:.fo,nearest well..----I' ------Distance from foundation___s'�fl.___.__.Di +anc�e to nearest lot line...... 6 P ,� 9 1e: Diameter._`- p Number of its-----:-'-------------Linin material_e� Cesspool: Distance from nearest well_______ _________Distance from foundation------------------- Lining material__-___---------__.-____-____________. ❑ Size: Diameter--------------------------r-----------Depth--------------------- ----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line ---------------------------------------------------------------- ----------- Remodeling and/or repairing (describe)•-------------------------------------------------------------------------------------------------------------------------------------- ------------------- ----------------------------------- ------------------•--------------------- •---•--------------------------------------------•--•---------------------•-•------•--------------------•-------------•-----------------------•-•---------------------------------- ------•-------------•-•-----------------------------•-------•-------••------- ------------.. -------•------------•-----------------------•--------------•--- ---------------------------------------------------------- I hereby certify that I have prepared this application and that 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) !{JUQ �- --------------•---- ------------------------- (Owner and/or Contractor) `it�� --------------------------------------(Title)---------t� ------- ------------------------- (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----------- f ---------------------------- --------- DATE------------ -------- ----------- DATE REVIEWED BY------------- ----------------------- - •----------------- ---- .- ----------------- ------------------- BUILDING PERMIT.ISSUED------------------------------------- --------------------------------------------------------------- DATE = Alterations and/or recommendations:------------------------------------- "- ---------------------------------------------------------•------------------------•--------- --------------------------••-•------------------------------•-•-------------------------- -----------------------------------•---•------•---------------------------------------------------- ----------•--------------- ------------•----------------------------------------------- ----------------------------------------------------------------------------------------------------•-•----------------------------------------•-----------•--_ -----------------------•-----••---------------•---------- ----------------------- ----------------- •------- -------- --------------------------------------------------------------------------------------------- FINAL INSPECTION BY:. Z Q 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 ES-9-2M 10-52 Revised W-2100 )