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Tr� _ APPLICATION FOR SANITATION PERMIT P Fmit o. _--_ __�... __ z / S Z — ��, f {Complete in Duplicate) N �"`-% Date Issued __ _4L-q---�; Y 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. i --- --------------------------------------------------------`--------•------------------- JOB ADDRESS AND LOCATION____-_�,___�_`�___ �.-_!-- -- ---- - --------- -- --- - Owner's Name--------------•--- - Phone ' ? = f� P f ! --------- C,(,_:---------•---------------------------------= ---------�---------- Address-----------•----------- 3 ---- --- �----' 4 1 °C` ---------------- Phone_ -- r' 4 � : Name------- -- - -----�--='��-.-��---�- �•�- ----------- Contractor's a Installation will serve: Residence ❑ Apartment House ❑� Commercial ❑ Trailer Court ❑ M tel ❑ Other Ell-- :- Number of living units: __ _-_ Number of bedrooms Number of baths ___,- .Lot size __-_-__ -- '-------------- Water Supply: Public system ❑ Community system ❑ Private ❑"'D'epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam E]_,Clay Loam E] Clay ❑ Adobe t Hardpan ❑ Previous Application Made: Yes ❑ No ' New Construction: Yes E!'No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) x Septic Tank'. Distance from nearest well_-�-.�---Distance from• foundation---_`__ -_.__.Mate- --- -------------------------------------------- ------ --____----'.G r _ No. of compartments---- -A---------- Size------ c��C -�"�---Liquid depth ` s� Capacity } Disposal Field: Distance from nearest well-- _ _--_.Distance from foundation-_lam-_-�_-Distance to nearest lot�line_� -------- ❑,� Number of Sines-_-___.. _--_ T - Length of each line--_c�_C�__ `� Width of trench----.:��--�---------------------- Type of filter material. _- !E': -Depth of filter material___p------------Total length----/2--�a----------------------- Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter------------------------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-------------------------------- ----- i --------------------------------------------------'-•--------•----------- . a x' 1 Remodeling and/or repairing (describe)--------:�----'"-`r------- /1,�'-- ----- ----------•-------•-•------------------------•----------••---------- r ---------------------------------- ✓ ------------------------------------------------------------- •-..........----------••----.._...----------•---------------------------------•--•-------•-----------•--------------------------------- -----------------------------------------------------------------,--------- - ------------- -----------------------------------------------------I----------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s?and rules ano regulations of,the San Joaquin Local Health District. T '�` ---- [OWne .8ftd�or ntractor) (Signed rle V- - i - �: �O, Title-------'J-�r l By:--------------------- f---- - ---- --U ---- [ ) (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------------------------- -- - --------------------------------------------------------------- DATE-------- -2'1""_------ REVIEWED BY------------------------------- ---------------------- -------------------------------------------- ---------------- DATE -- -- --- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------•-------- Alterationsand/or recommendations------------------------------- ------------------------'-------------------------------------------------------------------------------..-------------------- ----------'------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------- FINAL INSPECTION BY:-,-h,,- Date--4?.. e'-"" SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100