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e0%APPLICATION FOR SANITATIONRMIT Permit No. (Complete in Duplicate) Date Issued 1_`�.� Application P plicafion is hereby made to the San Joaquin Local Health District for a permit struct install theWjk herein described. 's _7;�4E� application is made in compliance with County Ordinance No. 549, ---------- --- JOB ADDRESS AND TI N. . ---------- ?q, 4------- ----------I---------------------- ----t------------------- --.-- Phone--------- Owner's Name------------------ --- -------- --------------- P1, ------ ------- ----- Address----------- ---- ---------------- Address------------J------ -------------- Contractor's Name-------------------------- ----------------- ---------------------------- ------------------------------ ---------------------------- Phone----•--------------------------- Installation will serve: Residence X Apar nt House E] Commercial [-] Trailer Court [] Motel El Other E] Number of living units: J.---- Number of bedrooms ---70"'Number of baths Lot size _------/. ---�_ ----- ----------------------- Water Supply: Public system El Community system [_1 Private A Depth to Wafer Table -------- ft. Character of sail to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [] Clay Loam El Clay'E] Adobe Hardpan E] Previous Application Made: Yes E] No &New Construction: YesA No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se;ver is available within 200 feet.) .0. Se ti Tank: Distance from nearest well----- fro f joion----/0---------M t ial---- T5----Dista,,nc Tf ------- No. of cornparfmenfs__.__!%ff!�----------.--Size- ...Liquid depth--..___ ---------Capaci y__ D'i po al Field: Distance from nearest well----715,0---Distance from foundation-- A-0 Distance to nearest lot I'ne__S,_,� Number of lines___.-- Length of each Iine2A0_!!_f1 PiWicK of french _X-4---- ----------------- Type of filter maferial_�Mhnnl_Depth of filter material_-I-Y- ----------Total length-- -'7,*, -- ----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation---I—------------rDistance to nearest lot line----------------- El Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depfh------------------------ ------ Cesspool: Distance from nearest well-----------------Distance from foundation.___-.---- -----_Lining material_.-.--.------..------.------_._____-'. '. El Size: Diameter-------------=---- --- --- ------ ----Depth---------------------------------------------------Liquid Capac ----- ----------------------947_�_ 1Q_1h_ — - Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----.__.______-_ ---------------- El Distance to nearest lot line__________________ ------- ------------ - Rem ,pyifiling and or repairing (describe : - ---------------------------------- -------- ----- -- --- --------------------------------I------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- ------•----------- --- ---------------r----------- --------------------------------------------------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 I e S .!j�ues a9d regulat* ns of the an Joaquin Local Health District. (Signed)----------- ----;4,v, --------------------------------------------------------------------------------------------(Owner and/or Contracfo�t. By:-------------------------------------------------a-------------------------------------------------------------------------------(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--------------------- - - ------------------------ ----------- DATE ,Al+era+ions and/or recommendations:------ ---- -- -- -------------------------------------------------------------------------------------------------- ----------------- --------------- ------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------- ------------------I------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- ------------------------------------------------------------------------- -- --------------------------------------------------------------------- -------------------------------------------------------------------------- ------------------------------ ---------------------- ------ ----------- ----------- ----------------------------------------------------------------------------------------------------------------------- ZFINAL INSPECTION BY---------------------- ------- ------- ----------------- Date-...-- ---- -------------4/ -------- - - ---------------------------- 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