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5 APPLICATION FOR SANITATION PERMIT Permit Na . ---��-.- Duplicate)D i C �4/( omplete n upDate 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�yCounty Ordinance No. 549. JOBADDRESS AND LO ATION....- frrc -d--a I (f----- -------- --------------------------------------------------------------------- --------- Owner's Name------------- -------------------- 1�'.._- .... Phone- 0'1 Address-------------•------------ -T/yc = / Contractor's Name--------•-- -�f__-4&-r` -ate`= Phone - f�� Installation will serve: Residencel[tj'`Apartment House ❑ Commercial ❑ Trailer Court ❑ M9teel I❑ Other ❑ Number of living units: _;��Community umber bf bedrooms -_L__ Number of baths ---!__- Lot size ��__!_�_-[-�4--__--------------------------- Water Supply: Public system system ❑ Private ❑ Depth to Water Table _A�_ ft. Character of soil to a depth of 3 feet: Sand ❑, Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: Yes [I No New Construction: Yes ❑ No t , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or,cesspool permitted if public sewer is available wiThiri 200 feet.) Septic Tank: Distance from nearest well___________-----------------Distance from foundation-------------------.Material-----------------------------------__-------_.._. ❑4164No. of compartments-------------- -----------Size------------•----------•--------Liquid depth--------------- ---------Capacity-----------------------5�11 DisposalField, Distance from nearest well-----.-----------Distance from foundation-----------------___Distance to nearest lot line____---..________ ❑ Number of lines----`-------------------------------Length of each line------------------------------Width of french------------------ -_--------••--Q Type of filter material-------------------------Depth of filter material____.----_.___._I-___._Total length--------------------------------------j_._� __ �_______.jVifance to nearest lot I'n�__ ___.__. Seepag .Pit: Distance to nearest well________ Distance from-foundation___ rr CR+��d - -- ----Depth-_o2_!i:-_Number of pits---------1--------.--Lining material-----------------------Size: Diameter---- - i Cersspool: Distance from nearest well_________________Distance-from foundation___-_---------------Lining material____-_______._----.________.______. Size: Diameter-----]---------------------------- ---Depth--------------------- ----------------------- Liquid Capacity----------------------------gals. I Distance from nearest building ----- Privy: Distance from nearest well------------------------------------------------- 9 --------------------------- - ❑ Distance to nearest lot line------------------- --------------------------------------------------------- -------------- -------------------------•--------------- ---- Remodelingand/or repairing Idescrille):-------- --------- -----------------------------------------------------------------------------------------------•------------------------------------ t l --------------------- ------------------------------- ---- ------------------------------------Ihereby certify that I have prepareg this applicati:-•--------•----------------------------------------------------------------------------------------------- on and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules andsi regulations of the San Joaquin Local Health District. ,, (Signed)------------------------------ t ---------------------------------------------------------------------------------------{mer and/or Contractor) Sy:--------------- •------ -------------------------- - Tale ------------------------- -- (Plot plan, showing size of tot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY �----------------- --------------------- ------- ---- -------------------------------- -• DATE:�_.------------------------------------------------ REVIEWED BY-------------------------------- ------ ------------------------------------------------------------------ DATE-- uN--------------------------• �t--------_-------- BUILDINGPERMIT ISSUED---------------- ------------------------------------------------------------------------------------- DATE-------V------------------------------------------------- Alterationsand/or recommendations=-------------------------------------------------•-------------------•------------ -----------------------------------••-•--•-•--•---------------------------- ---- -----------------------------••--------- ----------------------- ------------------------------- 1 -------------------------------•-------- --------------------1-----•--------------•----------------------- -------------------------------------- ------------------------------------------------------ - - i .a�, ��M �_ Date. FINAL' INSPECTION 'BY:_ _________________ __ ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street s no West Oak Street 132 Sycamore Street 814 North "C" Street F Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100