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F+ y 5 y APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date IssuedV-k) � l 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 r 3 � �` ' ----- '—�LD-E'-+ +--- 5 , 1� /� Owner's Name ------------------------•--- ------ ¢ ��= ------------------------------------------------------------ Phone-------------------------------- Address ---------------------3----------�' ``—�' " ---------------------------------------------------------------------------------------- Contractor's Name---------------- _D-v-1 C. Phone ------------------ ----------- ---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ___/__ Number of baths __-L Lot size ----------- _ ' x i4 ______ Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)' Hardpan Previous Application Made: Yes ❑ No X New Construction: Yes [] No X 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-----------------Distance from foundation--------------------Material ______-______.____________`__-_________________. 0,aJtrl lj (Y'lNo. of compartments------------ -------------Size----------------- --------------Liquid depth--------------------------Capacity------------- --------- Disposal Field: Distance from nearest well---4_Pr---------Distance from foundation �4f------__Distance to nearest lot line ANumber of lines______________ _______ Length of each line---------------7_S' ____ Width of trench______-____ ��_-�_______ _ Type of filter material-_-__r .p----_Depth of filter material____._____f "__._Total length________________________7--s --__ Seepage Pit: Distance to nearest well-------------------- _Distance from foundation......_-------------Distance to nearest lot line___________._____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth-------------_------------------- Cesspool: Distance from nearest well____-___________Distance from foundation__________________.Lining material------------------------------ ❑ Size: Diamefer--------------------------------------Depth----------------------------------------------------Liquid Capacity-----_--------------------gals. Privy: Distance from nearest well------------------------------ ------------------Distance from nearest building_________________-__ Distance to nearest lot line Remodeling and/or repairing (describe):--------"e—Y/_ - ------ ,. -----•---------------------------------------------------------•------------- --------- -------__---------------------_--:------------------------7-- ----------- -------------------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 Health District. A.(Signed)----- - ___-- ____ -------------------------- ---__Owner and/or Contractor By: -----------------------------------------------------------------------------------------------------------(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 ------- � . ----------------- --I --- - " --- REVIEW ED BY --------------- - - -- ------------------------------------------------------------ DATE BUIL ---------------------------------- DIN PERMIT ISSUED -- ------------------------------------------------------ ---------------------- DATE-- ---------------------------- -- - ------------------------ Alterations and/or recommendations-------------------------------.-----------------_-_--- - -----------------------------------------------------------------_----•----------- t - ------------ ------------------------------------------------------------------------ FINAL INSPECTIONBY-- ---- --- ----- _-- ------- 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