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a ,�-- APPLICATION FOR SANITATION PERMIT Permit No ----------- �� _ 1 (Complete in Duplicate) . Date Issued92!!.3__.5_3 ._....�_3 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 AND LOCATION---- ...... ---L._...................? ---- ................................................... - n Owner's.Name = n - ----------- o _- � ► --------------------------------- Address -------- ----- ---.3- Contractor's Name-.. -----•-_-------•------ ....... ............................................................................................ Phone--------------------------------- Installation will serve: Resicleni:4 Apartm t House ❑ /Commercial C] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...I-- Number of bedrooms -----t-_ Number of baths ---l___- Lot size ____ ......... Water Supply: Public system ❑ Community system ja Private ❑ Depth to Water Table -710 ft. Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan❑ Previous Application Made: Yes ❑ NO"--./ New Construction: Yes 0( 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. .-.1660.Distance from foun tion____. --_------.Ma# ,rial............................. ?rE • No. of c'om artments__-_ Size...... ___ -Liquid depth......_.__ _ Capacity Disposal Field: Distance from nearest well _� Distance from foundat•o 1d Distance to nearest I t lige S � ,,11 ------...... Number of lines_ ....__.•:.'tZt ..__ Length of each line�.'i__ �' � Width of trench _ 4 ` j ----------- Type of filter material--_-_�'_I�_�1_Depth of filter material.__..... ,0._-,•_.Total length...... p.C�. _-__ d Seepage Pit: Distance to-nearest well ------------------Distance from foundation ..._.__ ._..Distance to nearest lot line ❑ Number of pits----_---------------Lining material.......................Size. Diameter___-• .....__. -_-...Depth--------------------------------- Cesspool: -------- .---_---_ ----_----Cesspool: Distance from nearest well Distance from foundation Lining ---------------------------------- t - ❑ Size: Diameter-- --••-----•-..................Depth..........------------------------------------------Liquid Capacity_--------------..........gals: Privy._____a.:.. _------Nstance from nearest well-----------------------------------------------Distance from nearest bu.ilding___...---------------------------------- Q 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, Sta laws, an and re ulations 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 ---------------------------------------- DATE REVIEWED BY- ... - DATE �./ � ........................ BUILDING PERMIT ISSUED D, ........................... Alterations and/or recommendations ---------- -- -- - -....... ----------------------- - -------•-- _...... --..._........................................ 2---------............................................................ ---------------- ----•--•--- FINAL INSPECTION BY:... ......... 1 "" 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 8-51 Revised.W-2100