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_ - APPLICATION FOR SANITATION PERMIT Permit No. 23_.1_--__-- (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. a �. _ --------------- ---------------------------------------------------------------- JOB ADDRESS AND LOCATION---------- ----- -- -- . - -------- ---------- - ------------- Phone = Owner's Name-------------------------------- Address---------------------------------------------------------- ----- ------•-------------------------- ---- - ----------------- IT�tJc ----------------------- Phone _ -�' �Q Contractor's Name-------------------------------------- --- Installation will serve: Residence o Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1__ �� _ Number of bedrooms ._Number of baths ________ Lot size ------------- ._ _____ ----------------- Water Supply: Public system $. Community system C1 Private F1 Depth to Water Table �__�-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeQ Hardpan ❑ Previous Application Made: Yes ❑ NoX New Construction: Yes ❑ No ❑ ^'Y' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y� -- aterial Septic Tank: Distance from nearest well_f�----Distance from foun dation��--77-------M ' ----- No. of compartments Sixe- —2146 A ?S---Liquid depth------ --- -------Capacity---* E - Disposal Field: Distance from nearest well__�� ---Distance 1"rom foundation---14"r------Distance to nearest lot line________________' r�t Number of lines---------I------------------------Length of each line----------------------------- Width of trench___,✓-'!------------- ---- W �,to " Type of filter materia]_____`l�---_�►�'r --Depth of filter material____-_ -----__-_Total length_____A.Q_r------------------------- Seepage Pit: Distance to nearest well----H_d'�-_Distance from foundation___ '__Distance__� to nearest lo line__�_�_-. Number of pits---__-/--------------Lining material. l__Size: Diameter--------- --._.Depth_-__ ,4 -------------------- Cess�pool: Distance from nearest well__-_____________Distance from foundation__________________-Lining material_______--__.______-__._____-_______. ❑ Size: Diameter--------------------------------------Depth--------- - Liquid Capacity gals. Distance from nearest building - Privy: Distance from nearest well-------------------------------------------------- g---------- --------------------- -•----- ❑ Distance to nearest lot line------------------------- ------------------------------------------------------ Remodel ingiand/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 II ws) and rules and regulations of the San Joaquin Local Health District. --------------------Owne�evrMyy r Contractor] 5i ned `--- l l - Title <` syr------------- -------�. -�_-__._� .----------- ------------ - ------------- ------------- ----------- (Title) ------- ----��-__---- -- ------------------------------ etc., ----- --:------------- (Plot plan, showing siieof lot, location ofsystem in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- DATE.----------- Q- 7�, 1 2 -------------- REVIEWED BY----------------------------- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------- ------Alterations and/or recommendations:------------------------------- -----------------------------------------------------------------= i --------------------------------------------------------- ----------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ rDate..- 1 FINAL INSPECTION 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 Traey, California r ES-9-2M 8-51 Revised W-2100