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75_ APPLICATION FOR SANITATION PERMIT Permit No.(Complete,in Duplicate) (o _ �r Date Issued ----- Application is hereby made to the San Joaquin Local Health Distr lior a permit to construct.and install the work herein described. r This a plication is made in compliance with County Ordinance No.t49. y. .� JOB ADDRESS'AND LOOGATIO - _ _ r - fij---------,----- ,_Owner's Name__________ ________ _______ , .. - -- ---- -------- Phone Address '"� � •C4Z---------------------------------------------------•---------- -----• Contractor's Name ----------- Phone----------- - --------------------------------------------------------------------- -- i Installation will serve: Residence W Apartment House [] Commercial ❑ . Trailer Court ❑ Motel . ❑ Other.❑ Number of living.units: __�___ Number of bedrooms -2- umer o �-- ____Number baths ___ _ Lot size _ __ S7- i4t`--X-_1__�_•-�-�-.�y.:-'a:-'-•---- rT-+sem Water Supply: Public system ❑ Community syst Priv�,fie:.K,.Depthrto Water Table' ft. o Characfer_ f soil-to,a-dep#h-'of-3-feeti`Sarid Gravel Sand Loam a Loam �, ❑ Y ❑ Cly ❑ - Clay ❑. Adobe ❑ Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: YesX No ❑ n 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__ found tion____ ' , � ___ __Distance fra -- ----,Material ___` •!°_- -- --=--------- s"K No. of compartments_____--_ Size__- -; Liquid depth______ _i-Ca aci , Disposal Field: Distance from nearest well___ _>�__---_.Distance from foundation__ Distance to nearest lot lin Number of lines------------ I ----- --- ---------- ----------- Length of each line------------ --P-_---------Width of trench----_-`� Type of filter materiai-.__ _ _____Depth of filter material _____ /----Total length----- _ Seepage Pit: Distance to nearest well-------_--------------Distance from foundation----------------___.Distance to nearest lot line------------- n Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth--------------------------------- Cesspool: ----------------------_- - - esspool: Distance from nearest well__________ _____Distance from foundation---------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth------------------------ ---------------------------Liquid Capacity----------------------------gals. Privy. ., ,_—Distance from nearest well _- -------.Distance.,from nearest buildin ❑ Distance to nearest lot line______ __________ _________ Remodeling and/or repairing {describe)__________________ ----------------------------------------------------------------------------- ------------------------------I--------------•--•-------------••---------------•--------------------------•• ------------•-------------------------•----------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------•--•-------•-•------ = 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 l4ealth District. (Signed)-----------r -----------(Owner and/or Contractor) Ry:------- Title (Piot Ian showing (Title) -------------------------------------------- p g 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,__ REVIEWED BY------ --- ------ �,_;;�. ��• ,r TE_. -- ------- - --- --- DA --- _= -»- SATE -: BUILDING PERMIT ISS UED- ------ ----- -- ---- ---- -- DATE - -----$� ..._._. .,w terations and/or recommendations:_--------------- --------------------------------------------------------- ----------------- -.-_-,---------------------------------- --------------- FINAL INSPECTIONDate . BY:__-----__ - -----------------------= _ --------------------------- -------- 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-2I00