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r APPLICATION FOR SANITATION PERMIT Permit No. _-__�'-d_. .._ (Complete in Duplicate} / `li �• Date Issued -0/S�3 VAppIrication is he 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. � /�'6- JOB ADDRESS AND LOCAT N------- - Z. '4 0 ,/ h-- -------------- ----- ------------ /' r�� ----� ..�.- --------------------------- ----- Phone---f--- -(Q-6— Owner s Name-------------- •--,•-.,.:�. - 7 I � - _± -r ------------------------------- Address------------- --- -• -- ------------------- ------------------ - ------ -••----- - --- Contractor's Name----------- Phone----------------------------------- Contractor's will serve: Residence D�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I �� -7-0--- Water of living units: -------- Number of bedrooms _Number of baths __ _____ Lot size ____- --_ Water Supply: Public system ❑ Community system-[] Priate.,&Depth to Water Table Jp ft. Character of soil to a depth of 3 'eet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ New Construction: Yes No ❑ _ Previous Application Made: Yesj< No ❑ 9 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicseweris available within 200 feet.) e ' h/la r/a�l-'r '� ---------------- -------- Septic Tank: Distance from nearest w II� =-----Distance from foundation____ r� q Capaco#Y ?� p No. of compartmen s- ---------------------- Size--3 - -7--------- Liquid depth ---------------i-- X717 Disposal Field: I Distance from nearest well-,65--p------ r from foundation_____lb -- .Distance to nearest lotµ-1(S-/-- Number of lines --- h^•- ------ Length of each line-------�oCf:`f'---------.Wid#h of trench----------------------- �� Q Type of filter material__ _ -Depth of filter material_- ___ _e -------Total length...._------------j_s�____._____.-___`k Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____-_______---NIL❑ Number of pits----------------------Lining material-----------------------Size: Diameter__...------------------Depth------ ------------------------- M Cesspool: � Distance from nearest welL______._. _.___Dis#ante from foundation---------------------- _ _ ,_____.lining materia_____ __.__-______ ________________ ElSize: Diameter------------------ ------- -- Depth-------------------------------------=------- ------Liquid Capacity----------------------------gals, Privy: Distance from nearest well_______________________________ Distancelfrom nearest I'uilding--------------------------------------- ❑ Distance to nearest lot line-------------------------- -- ----------------------------------------- Remodeling and/or repairing (describe---------------------------------------------------------------- --------------------------- --------- - --------------••------`------'•------------------•- "----'-----•--------------------------------------- ---------------------------------------- --- r --------- -------- -------- --------•---- -- -----••---•--------------•---- ------------•• --------------------------------------••------------------------------•------------------------------------------ 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 �reg!ulations of the San Jo urn Local Health District. F ____________________(Owner and/or Contractor) (Signed}� - - -----------, -------------- ------------ ---- ------- ---------- ---------- - -- ---------- Title 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 APPLICATIONACCEPTED BY-------------------------- -- - - ---------------------------------------•-------------------- DATE--- -- ; - � SJ'�------------------ REVIEWED BY------------------------------------ --------------- ----------------------------------- -------------------------------- DATE.r fN - --------------------------------------------- BUILDINGPERMIT,ISSUED------------------------------- -- --- --------------- DATE,------.------------- ------ --------------------------------- Alterations and/or recommendations:_..----------------------------- ---------- --------------`•-------'--------"'" --------------------------------•---------------------------- ----------------------------------------- - --------------------------------I------------ --------------- -----•• i e �1 -„G1 --1;^ a FINAL INSPECTION BY J - 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 10-52 Revised W-2100