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np APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ------l�2 !•� Applica+ion 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 LOCATI 4. 1�-4_�_-___ A Owner's Name---- -- - - Phone//61f '� f Address-------------- !' �----""-- _ ---- ------ ------------- ---------- Contractor's Name---------------------------------------- - ----------------------------------------------------------- - ----- Phone----------------------------------- i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court: E] Motel El Other E] Number of living units: -f----- Number of bedroomso�_ . Number of baths --1---- Lot size _ _ _ -�__ - - ----- ------------------------------- i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 66P ft. " Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ -lay Loam Ell Clay ❑ Adobe ardpan El Previous Application Made: Yes ❑ No New Construction: Yes No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) # ,I q• 0' I Septic Tank: Distance from nearest well-�_.�.�._._Distance from foundation__/_0_* I_��l _`� "b- ---------------- No. _._�..�,._._. No. of compart f ants--_-.-�._.........Size...9XY ---------Liquid depth__.__3---4----______ Disposal Field: Distance from nearest well..-.\'5__q---Distance from foundation--/-($-----------Distance to nearest lot line.U�_____. Number of lines __,_51................... Length of each liner . " ___ _ "+ Width of trench_,..__..__..______._ Type of filter material: 'P�-_--_Depth of filter material-_.-9 -.._.--.Total length------/} p--_---_____-_-______.- t Seepage Pit: Distance to nearest well____________________Distance from foundation--------------------Distance to nearest lot line----------------- El . Number of pits--I---- --- ----------Lining material---------------------- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation- --- Lining material____---._-_-.-._____-----_.__---_---. Ly ❑ Size: Diameter-- ----------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. [� Privy: Distance from nearest well-------------------------------------------------Distance .from nearest building____._____-____._______________-------.-. �7 ❑ Distance to nearest lot line --- ------------------- --------- -------- - ----------------- ----------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------I------------------------------------------------------------------------------------------------- ------------ -----------•-------------------1-----------------------------------------------------------------------------------------------•--------------------------------------------------------------- 1 ----------•-------------- - •-- -------------------------- •----------------------------•-------------•--------------------------------------------------------------------•----------------------------------------------- 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 regulbtions of the San Joaquin Local Health District. (Si ned)•-----`• 1 -------- ----------------------------------- ---- - -(Owner and/or Contractor , (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ,i j FOR DEPARTMENT USE ONLY i--------- --------------------------------------------------------- DATE------'�- -- APP!*lCATION ACCEPTED BY._._._..:. REVIEWED 13Y - -- - -. DATE BUILDINGPERMIT ISSUED------------------------------------- ----------- -----------------•-------------- ------------------ DATE--. ----------- ----- --- ------- - ---------- Alterations and/or recommendations F -------t----------------------------------- •-••--•---••--•--------------------------•-----------------------------------------------• =- � ---•------•--------------------•------------------------------1`--• ------------ ------------------------•----- -------------------..........................------------------------------------------------------------ -------• •--•-- •-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-_-•----•-------------- 1 { FINAL INSPECTION BY: ----------------•--s----------------------------------- Date------ J c5 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 T45449 ATWnno 12.54 -