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I� APPLICATION FOR SANITATION PERMIT Permit No. � .. v' (Complete in Duplicate) Date Issue 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. I � 'l JOB ADDRESS AND LOCATION________________ ��f-_ _ - = ---•-•-----_ -----•-._. Owner's Name = ----------- Phone.__' Address -7-- --------------------------------------------------------------------- --------------------------------------- ---------------•--------------- � - Phone------- Contractor's Name---------------------------------- ' ------------"��' '� --------------•------- � Installation will serve: Residence J& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms-_ Number of baths ._.fes. LOt sae ____._ —__ . �---- Water Supply: Public system�Community system Fl. Private [I Depth to Water Table/?Zaft. Character of soil to a-depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑��F��` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-IJ-0______Distantj�prom fo urdation 1-�----•-------Material-------- ---------------------••---�------- No. of compartments.--rY----- --------Size�4___X_6_r�__. +_Liquid depth__.¢_ .I�---------Capacity---/000 --- 1,9 " Z_ Disposal Field: Distance from nearest well- l-0-..----_Distance from foundation__1___________-_-Distance to nearest lot line___ v l Number of lines___----------r__y_______---Length of each line _' --__._. ____.Width of tren h,2 _ P Type of filter material._ . 3---Depth of filter material.-_l.$.--------__Total length�,a� .......... Seepage Pit: Distance to nearest well_,��_�_-_ Distancef osm foundation---,!__a_-------Dist`�e to nearest Iot'Iin��-_____.._ � Number of pits.-------------------Lining material. -- -------Size: Diameter_ ------------Deptn_ _____________--_--. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_--_______._.-.--_____-_-_.--______ ❑ Size: Diameter--=-----------------------------------Depth------------------------- -----Liquid Capacity-. ------------------ gals. IDistance from nearest building Priv Distance from nearest well ----------------------------------------- -------------------------------------- Distance --------------- ----------- ----- - r y:. - ❑ Distance to nearest lot line--- -------------------------------------------- ------------------------------------------•-------------------------------------------------- - t r Remodeling and/or repairing (descrribe):-------------------------------------------------------------------------------------...------------------------------------- ------------------------------------------ ------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ------ -------------------------•----------------•---•-----------•-----------------------------• ------------------ ----------•------------------•-----• -------•------ •----------------- ---- . I hereb rtify that I have repared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, to laws; Ad rule id regula ions of the San Joaquin Local Health District. (Qmwwmawd#aw C ] (Signed)._-- ---- f ntract - - --------- - ---- - -------------•----------- (Title) "�f ----------------- (Plot plan, showing size of lot, location of sy to in relation to we , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------------------- �-- ---------------- -------- DATE__- ----- — — r A 57 REVIEWEDBY------------------------------------ ll ----- ------ ------------------------------------------------ N -_PERMIT ISSUED---------- _ ---•--------- - - DATE_. : Alt rations and/or re mmend tions:_ �-- -------;Ink-e- -- ----- ------1 ��" t_ ---------------- ----------------------------------••-------------------------------- ---------------------------------------------------- ---------- ------------------------------------------•--------- -----••-------------•------------------------------------------------- t / - " FINALINSPECTION BY:. -- ---- -----i � � �--�--------------... Date.----------- ---- ---------------------------------------- SAN ---------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streof i 30D West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised W-2100