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G1, d APPLICATION FOR SANITATION PERMIT Permit No. , F . (Complete in Duplicate) / ._-- -- Date Issued Aa 6.__gj Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor4hin described. This application is made in compliance with County Ordinance No. 549. �` '� JOB ADDRESS AND LOCATION ^-------J�- `� � ..................................-------- ---- Owner's Name.................. •.. . r,._-�_ ?!t- Phone. Address-------------------------•- -------------------------------------------------------------------------------------------------------------------------- - Contractor's Name-------------------------•----------------------------------------------------------------------------------------------------- - - - --- Phone---------------- ------ Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/-__ Number of bedrooms__>---- Number of baths .1----- Lot size ----4._Q.1_S__---1.--0__.v______________________ Water Supply: Public system ❑ Community system fZ Private ❑ Depth to Water Table .l __. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam jZ] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes (50 No El TYPE OF INSTALLATION AND SPECIFICATIONS: M (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest .__Distance from foundation--•-14' ....._..Material;, C-4! r•___------ 77 ® No. of compartments__._.._-._____. �' -•-Size. _ Z._�_____._.Liquid depth----3.__.6..._-_:.-_.Capacity...tf_3-7_94, Disposal Field: Distance from nearest well---= Distance from foundation_..1,6 Distance to nearest lot line .. ❑ Number of lines. _.'_- c __ Length of each line--------_lo.G__.�f_-____ ---Width of trench �� Type of filter material-----T' ._----:Depth of filter material-----!_F_-_---------Total length............ ................. Seepage Pit: Distance to nearest well__ _ _______________Distance from foundation....................Distance to nearest lot line................. O ❑ Number of pits----------------------Lining material__---------------------Size: Diameter------------------------Depth--------------------•,----------- Cesspool: ___-_---_Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------- ....... Sizer Diameter--._: - -_.----- ----------_--Depth----- -- - --------- - -------- ---_.-_-Liquid Capacity-------. _ ---_.._..-------- ._.gals, Privy: Distance from nearest well----------------------------- _______ __Distance from nearest building........................................ Distance to nearest lot line----------------- --------------------------------------------------------------- ----- -------- -------------------- ------ Remodeling and/or repairing (describe):-------- -------- ------------ ---------------- -------------------- ---------------------------------- •------- ------ - ------------------------------------- --- --- ------------- -- ---- ----------- ---- -'-••---------------------------------------- ---- --...........................................--------------------------------------------------------------.......................... 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. • - + :. _______ __Owner and/or Contractor (Signed)------------------� �-----` ------- -- ------------------ - -- --- ( / ) By:-------- ------------------------------------------- ....—-------- ---------------------------- -------------•_(Title)---------------------------------------------------------------- (Plot -------- ---------- ------ --------- (Plot plan, showing sae of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U E ONLY APPLICATION ACCEPTED BY--- - -- = - -- ------ DATE--- Z- - ------- ------ REVIEWEDBY--------------------------- ----- - ------ - DATE------------------------------------------------------------ r\ BUILDING ------ ------------- BUILDING PERMIT ISSUED-- -- . _ ®?ATE`. --- ........1 Alteratio and � /or commend tions: A __�� . Af ..... -'= -------------- .!_ ."_,% '-�- --.----------- - ------ ----- ------- ------ J FINAL INSPECTION BY:.... .. . 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