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'APPLICATION FOR SANITATION N PERMIT Permit No.5_16'137. ' (Complete in Duplicate)i � Date Issued �/-715�.3 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 wi h County Ordinance No. 549- • ..., . JOB ADDRESS AD LOCATION. _-___--� -- -- ------------- Owner's Nam S Phone-�-'-�-�- -----{-------- ----- -- . Address ---------------------------------------------------- 1 ----------------------------------------------------------------------------------- ContractorName---------------------- - ----------------------------------------------------------I----------------------. `------------------------ Phone..-------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Molel ❑ Other ❑ Number of living units: _'l--- umber of bedrooms 13_ Number of baths Lot size _5�� __ _______-_____.____________.____.__-_ Water Supply: Public system Community system ❑ Private ❑ Depth'to Water Table ------- ft. Character of soil to a depth of 3 feet: S;��New Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes No Construction: Yes No 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-----------------Distance from foundation--------------------Material---------------------------------___.._____ ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity------- ----------- Disposal Field: Distance from nearest we11__----------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------__--------------Depth of filter material-----------------------Total length------------------------------- i Seepage Pit: Distance to nearest well-...__________________Distance from foundation--------------------Distance to nearest lot line_______._________ 0 Number of pits----=--.---------------Lining material---------_._-----------Size: Diameter-----------------------Depth------------------__--------___-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____.------------------------.______. ❑ Size: Diameter---------------- -- Dep�h-------------------- -----------------------------Liquid Capacity- ------I--------- ---- ----gals. Privy: Distance from nearest Well________ __ _________________________Distance from nearesr building--"1500.-------------_--_.__._____ Distance to nearest lot line--.�-- Remodeling and/or repairing (describe)----------------------------:-------------------------•----•----------•----------------------------------------------------------------------------------- i ---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------••--------------------•------------------- P ------------------------------------------------------------- ----------------------------------------------------•----------------------------------- ------------------------------------------------------------------ f 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 rues and(regulations of the San Joaquin Local Health District. (Signed)__ _____________(Owner and/or Contractor) # 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 DATES ------------ ------------------------ REVIEWEDBY - ----------------------------------------------------------•----------------------- DATE-- �.�----------•-------------•-----•-------------- BUILDING PERMIT ISSUED----------------- ----------- DATE Alterations and/or recommend tions:-1-------------------.. ...... --------------------- -------- --------- ------ V------------------ --------------------------- .Q c, --------- ------------ - - -------- 2 -- -- - - -------- .�-. c FINALINSPECTION BY---------------------------------------------------------------- Date -------- ------- --- ------ -------------------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manfeca, California Tracy, California t ES-4-2M 10-52 Revised W-2300