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APPLICATION FOR SANITATION PERMIT Permit No. .._`T-. _r�__ (Complete in Duplicate) Date Issued .---1_____________ _• 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. 0j,0 JOB ADDRESS AND�LOCAT ON. ��3i`"�-v - ------------ -- Owner's Name---_ 1 J.. r Phone ------------------------------- ----------------------- ------------- Address I r� -�---` Contractor's Name--------•-----•-•------------- ------ ---------------------- Phone------------------------------------ Installation will serve: Residence & ApartmenjHse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: . /-__ Number of bedrooms _ Y Number of baths ____ Lot size _ A f -- - -- --- /--- - --- ------ Water Supply: Public system ❑ Community system ❑ Private Depth to Table __��. Charaefer of soil to a depth of 3 feet: Sand Gravel Sand Loam Cla Loam Cla Adobe Hard an P ❑ Y Y C� Y ❑ ❑ P ❑ , Previous Application Made: Yes ❑ No 0 New Construction: Yes [3 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.), Septtiiicc Tank: Distance from nearest well__a�40_f_Distance from foundation-_-Glx----Material_____ __ T� �/ r No. of compartments----------'Y---------Size---T..XkX--�----------Liquid depth-------_--�.--------.CapatitY---�G-a---------- `. Dispo al Field: Distance from nearest well____ istance from foundation__V_./�.-_....Distance to nearest lot line__�� ______.. Number of lines-------1--------------------------Length of each line----- _�_.�____�j_.Width of trench---------J 0 �f__._____--- Type of filter material--S'r?7:- Depth of filter material---------/- ---Total length------,_. __ ____________________ Seepage Pit: Distance to nearest well-,2,-� _�---Distance from foun io __-_�Q-__...___-D&nce to nearest lot line____ --------- Number of pits---------✓-----------Lining material__ C. ____ Diameter__ Vnin� --D A....... ___ ___-_____._ Cesspool: Distance from nearest well________________Distance from oundation.._.------------Smat�ial ______.._.___.________._ --.__-___� ❑ Sizc: Diameter------------------------------------- Depth---------------------------------------------------Liquid Capacity---------------------- ----gals. _}ti Privy: Distance from nearest well____ _________________________________Distance from nearest buliding----------------------------------------- ❑.2-a/-.:; Distance to nearest lot line___ ______________ IV 7116 4ZAV� Remodeling and/or repairing (describe):__ __ _ __ _ ________ ------------- 0 - n- 0 _ ----------- , I hereby cd�tify that I have prepared this applica ion and that the work will be don accordance with San Joaquin County ordinances, Stattee laws, and rules and regulations of the San Joaquin Local Health District. {/ ��-- �ER/1r- ------------------------------------------------(Owner and/or Contractor) (Signed)_.,)_,e---------- -�------- ------ - BY:------------------------------------------------------------ --------------------------------------------------------------------(Tifle)------ ------------------------------- ------------------------ (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------ - REVIEWEDBY--------------------------------------------- --------------- BATE -.�.. BUILDING PERMIT ISSUED------------------------------- - ------- --------- DATE--- --------------------- Ater tions nd or recommendations:___ _____________ __ _ __ __ __ __------------------------ -------------------------------------- - -- --- -- � - ----- = : __: FINAL INSPECTION BY------ -------- ------ _ Date----------------- Z 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