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k / APPLICATION FOR SANITATION PERMIT Permit No.o_2_"§-_./ i AJ (Complete in Duplicate) r�_� - v�• Date Issued _____/_4 plication 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 Ordifance No. 549. JOB ADDRESS71) OCATION L----------------- -- ___ -----------------------------------.._____-______.__________________________f__________._.__/ "J Owner's Name d ----------- ------ Phone_-•----�4,0.0 -----L Address_.----� 1757-- -----------------------------------------------------1-1-------------------- Confractor's --- ---------------------------------------------- Contractor's Name -- --------------------- -------- ------------------------------------ -- - --- Phone_ j Installation will serve: - Residence 11 'Apartment House ❑1 Commercial E] Trailer Court ElMotel�❑ Other ❑ i Number of living units: ---1/ Number of bedrooms ---1---- Number 'of baths __-_1__ Lot size --- --- Water Water Supply: Public system Kommunity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a•depfh of 3 feet: Sand Gravel ❑ Sandy Loam E], Clay Loam ❑ Clay El Adobe Hardpan E]Previous Application Made: Yes E] No New Construction: Yes [}/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sefwer is available within 200 feet.) ) r Septic ank: Distance from nearest well__ 0---Dista from rr pund i pn----Lo------.Mat r�al------ --------- �_ y�&. No, of compartments____________ Size_ _x__ -- .Liquid depth____________________Capa P t I R Dispos Field: Distance from nearest weft P-----Distance from foundation____; _�- _�-__rDistance to nearest lot line_'__reF Number of lines____________ ___ �_____ Length of each line___�__�___� __ ___.Width of trench______ ___ � -'�__- Type of filter materia_ ___+ "C epth of filter material._______'__ ______Total length_______.--.-��_.0__-__ ------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation Number to nearest lot fine__________._.____ ` ❑ Number of pits----------------------Lining material---._•-----------------Size: Diameter-----------------------Depth-------------------.-------------- + Cesspool: Distance from nearest well-----------------Distance from foundation--------------._----Lining material-----.----------..-_____ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------.-----Liquid Capacity--•-------------- ------gals. Privy: Distance from nearest well----------------------------_--------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line Remodeling and/or repairing (describe):------------------------------------------------------- --------------------- -------------------------- --------------•-----------------------------•---------------------------•--------•---------------------------------------------------------------------------------------------------------------------------------.------- -------- ----•---------------•------------------------------- --------------------- •--------------•----------------------------------------------------------- ------------------------------ ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S �aww and rules and e-.gulatio s of the San Joaquin Local Health District. (Signed) ------------------ --- Owner and/or 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 -------------------------------- REVIEWED .BY---------------------------- ---- ----------•---------------------------•---------------------------------------- DATE----�7 { r •--------------------- BUILDING PERMIT ISSUED----------------- ----------- --------------------------------------------------------------------------------------------------- DATE------ -__9S3 Alterations and/or recommendations: - ---------------- -----------------•__--------------------------------------------------------------------------•---------,-.--------------•---•---------•-------------------•--------------------•-------•--------------•----- ------ -•------- FINAL INSPECTION BY:------------ ------ Date L, J 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 B-51 Revised W-2100