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'= APPLICATION FOR SANITATION PERMIT Permit No. ___ ._�- ---- ` fi (Complete in Duplicate) , -I `S Date Issued 89 I 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 nt ae No. 549 • - --------------- JOBADDRESS D LOCATLON------ � ------------------------------------!''-------------------------------------------- -- - Phone- , - ` Owners Name------ •--- ------- Address---.e .. -._ -"---- ' ----- ------ ----•--------------------------------- .... ` Contractor's Name------------- -------- - Phone Installation will serve: Residence Apartment House ❑ Commercial Trailer Court Motel Other El Number of living units: J---- Number of bedrooms --- -__ Number aths ---1--- Lot size . _- _- _ Water Supply: Public system 11 Community''system [I Private Depth to Water Table -------- ft. /- Hardpan Character of soil to a depth of 3 feet:i Sand E] Gravel ❑ Sandy Loam ElClay Loam ElClay C] Adobe ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public swer is available within 200 f t{)� j /� L! Materi It----- Septic nk: Distance from nearest well-_ _O-O__--Dista ce fro fou anon------- -- --- -- No. of compartments----------�---------/.Size)--x- _ .---Liquid deP1h-------- -------- .Capacity Dispos Field: Distance from nearest well_ _._:�-__-.-. Distance from foundation--- _ �t---.--Distance to nearest I t ire// Len 4b of'each line_-----__ - O. Width of trench- ---lam Number of lines------- ,{,�,, 9 1 7 -- ----_.-- epth of filter material--------1--(�-------Total leng#h---.`_ -------------------------- Type of filter materitYG/�-0 Seepage Pit: Distance•to nearest well----- ------------Distance from foundation-----__.__----..___.Distance to nearest lot line__-_-_--_------.- ❑ Number of pits-------"-------- ------Lining material-------------------. -Size: Diameter-- -•-----------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.----.--------------------------------------- r ElSize: Diameter-'--------------- -------------------Depth-----------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from.nearest well---------- ------ ----- --- ------------------Distance from nearesf building------------------ ------- ------- ❑ Distance to nearest lot line---------------------------- ---------------------------------------- -------- ------------ rT.n r Remodeling and/or� pairmg (describe):-------------------- -----------------------------------------------------------� I-------------------I--------- F ! ---------------------------- -----------••-•------------------------ ------------ -------------•------ i.t ------- ------ -- ----------- 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 rules ai d regulations of the San Joaquin Local Health District. (Owner and/or Contractor (Signed).. G .... ,r•t r -- - --------------- -------------------{Title)------"--------------------------------------"- ------- -------- By:----:-------•-------------------------- ---------------------------------------------- (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----------------- ------ -------------------------- -- -------------------------------- REVIEWED BY---------------------------- DATE - x, BUILDING PERMIT ISSUED------. DATE - = Alterations and/or recommendations:--- ----------- -- -. -------------•--•---•-----,----------------------------------------------- I -- ------------------------•----_ .. = - �/ = . _ - - s ---- --------- y --_--------------------------------- ------------------- -- -- - -- ----# -"--------------------- --------------- — Ixk Date -- ---------------------------- FINAL INSPECTION BY:.-_____.._'-------- -- -- -- - ----- ----- - - -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT '`" 130 South American Street 1 300 West Oak Street 132 Sycamore Street 814 North "C"`Street Stockton, California Lodi, California Manteca, California Tracy,(California r 4 ES-9-2M 10-52 Revised W-2100 �► -