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APPLICATION FOR SANITATION PERMIT Permit No. .`�7.__:,.__. (Complete in Duplicate) Date Issued 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.A..Z----&4— ,l _ _._. Owner's Name-----------------------------------Wj-h-� - .: Phonei - ---7��j 1 ------- I Contractor's Name--------------------- •------•-- ----------------------------------------------------------------------- Phone.-Y—P4 ---•-------� Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /_____ Number of bedrooms .../__ Number of baths ._/___ Lot size ____> d_ ? _._/_&V-•_____________________fc7 Water Supply: Public system ❑ Community system Private-+W Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ AdobeEL Hardpan ❑ Previous Application Made: Yes ❑ NoJC,_ New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubric sewer is available within 200 feet.) .4S; Septic Tank: Distance from nearest well..._W"'_Distance from foundation__k.-_...._._..Material__._-__. .___ No. of compartments---a---- ------.-.---Size ----------Liquid depth--•--57--_-J'-"--------Capac, ty `:p--- ---- Disposal Field:Field: Distance from nearest well___1 °l Distance from foundation.../_-'-----Distance to nearest lot line--_rf .`~,.. Number of lines_______________ __�.---i_ -_ Length of each line....160--_-----.-_..-.Width of trench.,'X_V_C!----,_-__-._.-...__ Type or filter material-------/!__4i---Depth of filter material-----1:'r.........Total length___46.O.---_----------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distano4Zta-nearest lot line----------------- ❑ Number of pits----------------------Lining material-----.-----------------Size: Diameter.......................Depth:-------------------------------- Cesspool• Distance from nearest well•----------------Distance from foundation_-..----------------Lining material------------------------------------- 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-:_-___.----------------------------------------Distance from nearest building:-:_:____-__.__._-______-.--..___.__---_. ❑ Distance to nearest lot line----------------------------------------------------------------------- •------------------• -----•------------------------------------ Remodelingand/or repairing (describe)--------------------------------------------------------------------------------------------------........... .................. ------.......... ---------------------------------------•-------...--------------------------------------------•-------------------•-----------------------------------...-------------------------------------------------------------------- ------------------------------------ -----•---••----•••------•----•-------•--------•-------••-------•---•-----•-----------•--....................•-----------------------------------•--------------------------------------- I hereby certify that I havepr ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a d pulations of the San Joaquin Local Health District. (Signed)•------------------------- •--•-- ........ ------------- --------------------------------( /or Contractor) By:......... •-_...._ ---- ------ ------------ -- Tale--- (Plot plan, showing size of lot, location of system in relation wells, buildin , e+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--6)- `=='+--------- ---------••---- ------ DATE------------'Y � � ------ REVIEWED BY ----------- DATE.................. ...........................�' BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE............................................................. Alterations and/or recommendations:-----------------------------------------------------------•--------------------------------------------------------.... --------------••------- -----------------------------------------------------------•=------------------------------.....--------------•----•-------------•------------------.....--------------•------•--......--•-----•------••-. ......-----•---•-- ............ .-------------------------- --------------------------------- ----------------------------------------------------------------------- -------------------------- ------------------ -._ x ..-*,/- Z-3 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 10-52 Revised W-2100