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t/1/ APPLICATION FOR SANITATION PERMIT Permit No. _- --�`-- (Complete in Duplicate) l 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. JOB ADDRESS AND CA ION------3/3 ---------------------------------- Owner's Name ,1 (` 1 / ------------------------------------ -------------------------------------------- Phone- A ! _, lly - Address------------------ Contractor's Name !/-OT_-f7... ,[ -e-�----------- Phone,.,"-- Installation will serve: Residence Apartment House ❑ -Co"mmercral Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- ---- Number of bedrooms __-- Number of baths _?.__ Lot size __-/d4....X.1 0-0-------------------- Water Supply: Public systemCommunity system ❑ Private ❑ Depth to Water Table -------- ft. _ Character of soil to a depth of 3 feet: Sand ❑ Gzavel ❑ Sandy Loam ❑ Clay Loam Clay [__1 Adobe Hardpan E]Previous Application Made: Yes [-] No New Construction: Yes ❑ No [t�-F�I /VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well-----------------Distancelfrom foundation--------------------Material------------__-____--------------------__-----. ..�.a�K o. of compartments--------------------------Size--- f-----------------------Liquid depth----- -------------------CapacifiY----------------------- Disposa/l Field: istance from nearest well-----------------Distance from foundation--------------------Distance to nearest ]of line--_-____------- umber of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- pe of filter material-------------------------Depth of filter material------------------.-.--Total length------------------------------------------ Seepage Pit; Distance to nearest welf____' F-Distance from foundation_ __._-_.pistanc��to nearest lot line. --�_ Number of pits------- ------------Lining material-__Y!�_ - size: Diameter___- - Depth__-_a-S-7----------- ---.-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_____------------.----------_-----. P --------------------------------------------------.-Liquid Capacity- - ------------------------gals. ❑ Size: Diameter------- ---------------- ----------De Dept ----------------------- - - Privy: Distance from nearest well-------------------------------------------------Distance from nearer# building---------------_----_-__----..-------.-. ❑ 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, State laws, and rules an Sregulafions of the San Joaquin Local Health District. -- /D 00-7-gyp (Owner and/or Contractor (Signed) By-------------------• .----- E (Title .................. (Plot plan, showing a of lot, Iota ' n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------------------------------------------------- DATE------------------------ REVIEWEDBY--------------------------------------------- ----------------------------------------------------- ------------ DATE-------------- BUILDING PERMIT ISSUED-------------------- -------------------------------------------------------------- DATE Alterafi��an_d/or recommendations--------- -- -- -------------------------------------------------------------------------------------- r � ------ - ---- ----------------------------------------------------------------------------• --------------------- --------------------------- ---------- -- - -- - ------- ----- ------------------------•--------------------------------•---------- -------------------------------------------------------------- ----- -------------- ----------------- ------------ -----------------------------•---------------------------------------------------------------- FINAL INSPECTION BY:. f Date -- y------------------- ------•------------------ --------------------------- 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 Revised 1.57 F.P.CO. 1