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2�g�3 K 01(^- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .71-4n,153 Applica ion 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.. U Q �Q e --- -`* Owner's Name.............. - -------- - --- - ---------------- ---------------- ------ ---------- ------ --- Address 1rs'll �!�' '.2' Contractor's Name................................................- ------- --------------------------------------------------•----------------------------. Phone Installation will serve: Residence> Apartment HouVe E]//Commercial E] Trailer Court ❑ Motel ❑ Other E]Number of living units: __.�__ umber of bedrooms -_-L Number of baths J... Lot size .......o_Q_._X.J.Q_.t________________________ Water Supply: Public system ❑ Community system ❑ Private)& Depth to Water Table ;LSft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No IM"I New Construction: Yes 1I 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 'eY CSstan farom fo n at. ' � Material__C. ---�°---- ----------- No. of compartments----------�------- --Size_- � Li uicl depth._-__--.--____ "---._Ca Capacity ____------------ Disposal Field: Distance from nearest welI&V-"3Ilgs1;ance from foundation.... ........Distance to nearest lot,lin , . (�( Number of lines______________ _ ______ Length of each line______, Q_t-3 Width of trench____:+Z_j°—___-_-___._..--_--_-___ Type of filter material-___i�__e U�'�Depth of filter materiaL______t_.�-____._Total length______�jQ___________________________ Seepage Pit: Distance to nearest well-----------------------Distance from foundation....................Distance to nearest lot line--____-____-____- �J ❑ Number of pits____________________ Lining material----------------------- Diameter--------------.---------Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation. ____•._-.__.__..Lining material------------------------------------- F1 _-__ ____------.- __--___--❑ Size: Diameter - . . Depth............... _----------------- _Liquid _Capacity---------- -----------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building---------------------------------------._. ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------•------------ --------------- ��i Remodeling and/ rep ing (describe):___' -. .__._47� J_ ..... ............ ... J ��// q ------------------------------------------------------------------------------------.-------------------------- -------•---•---------------------------•----•--------------------------------------------•------------•----------------------------------------------------------------- ----------•----•----------------------------- 1 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) --� . -------------Owner and/or Contractor By:. ----------------- (Ti+le) ----------•------------------------- (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 ••. . - $- 27 DATE REVIEWED BY................ . - g DATE �'.�[-_._. . - ---- BUILDINGPERMIT ISSUED..................................................... --------------------------------------•-------- DATE................. -..................................... Alterationsand/or recommendations:------------------------------------...............................................................................................--------------- -----•--•-----------•••------•--- ---------------------------------------------------------------------------------------------•............................................................................................. ------------------------------------------------------------ --------------------------------------------........ ............-------------------------------------•-----------------------------------..------•--- FINAL INSPECTION BY-------------- ----------------------------------------------- Date------------�0 - ' - '� .- 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