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APPL�CATiON -FOR SANITATION PERMIT Permit No. -- •- `,�� Si �4F (Complete in Duplicate) Date Issued t 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. , R !1 - ----------------------------------•----------------------- JOB ADDRESS AND LOCATION f 7 ` � -------------------�--�------- Owner's Name------------ S r �+/} ------------------------ Phone------------------------------------ -- t = r Address----------------------- d •'� Contractors Name------�:._��.x__��_�_r.-'�-��----------- ---------=-------- ---------------------------- Phone Phone--------•-------------------------- Installation will serve: Residence 91 '.Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___L Number of bedrooms _J_._-_ Number of baths .__f__ Lot size __( ------- ------------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table y6-. ft. Character of soil to a depth.of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No 4 New Construction: Yes [�j -No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:S rl,hr�Distance from nearest well_________________Distance from foundation-------------------Material------.------------------ - ❑ � No. of compartments----- ------ - -----------Size--------------------------------Liquid depth---------------- ---------Capacity---------------------- y , Disposal Field: Distance from nearest well..................Distance from foundation--------------------Distance to nearest lot line___--_________- ❑ �x;Si Number of lines----------------------------------Length of each line-----------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------f---Total. length----------------------------------- � Seepage Pit: Distance to nearest well.._/��_Q_/V4---_Distance from foundation- -� -_______.Distance to nearest lot line{ �f_. _�_ `~t' Number of pits--------- ----------Lining material--<C �?r't/ttize: Diameter---3_J__-1�r_ Depth.------" Cesspool: Distance from nearest well-----------------Distance from foundation___._.__.---_______.Lining material---------------------------------- ❑ Size: Diameter = Depth ---------------------Liquid Capacity--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------- ------ ❑ Distance to nearest lot line--------------------------------------- ---------------------------•--------------------------------------- Remodeling and/or repairing (describe):------194 --------•------0_P? 27 f'_44f7-'0--- -------------------------------------------------- a ------------------------------------------------------------------- -------------------------•--------•----•----------------- --------------------•------•-----------------------------•----------------------- - - - ----- --- ---------------------------------------•-------------•------------------- ------------------------ -------•-------------------•-------------------------------------------------------- I hereby certify that h have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. f ` J_B- '�---------------------------------------- - ---------- ----- Owne d/or Contractor) {Signed) = = �� ---------- j I 6 ------------ {.Title) -------------------- By: -[Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,6can be placed on reverse side}. l FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY--- -•-- --------------------------------------------- ---------------------------------------- DATE -= REVIEWED BY ----------------- ---------------------------------------- DATE_ --- --- --- BUILDING PERMIT ISSUED DATE- - ATE - e Alterations Alterations and/or recommendations: - --------------------- ------------------- ----------I--------------------------------------------------- •--------------------------------•------------•- ' ---------- ---------------------------- ----------------------------------------------------------------- Date `1> - , _P` _ - -------------------------------- FINAL INSPECTION BY-._-_ -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street in Sycamore Street 814 North "C" Street F' , Stockton, California r'�.� Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100