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0. , APPLICATION POR .SANITATION PERMIT Permit No. '" - (Complete in Duplicate) _ Date 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 compliancewithCounty Ordinance No. 549. Ft 3 G7.sem:riWIF I z r"f A-_ y2-0 JOB ADDRESS AND LOCA ION_______ '�-____ _ - ? -��Or C.ac�r Owner's Name _ - ------------ Phone = ' .. -.._,f..------ � Address Contractors Name-.-------_-- --------------------------- Phone Installation will serve: Residence Apartment House EL Commercial ❑ Trailer Court ❑ Mote` ❑ Other ❑ ( ----- Number of living units: �__-_ Number of bedrooms ________ Number of baths __��___-_ Lot size ��-�;��_____ ------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑' Iardpan ❑ Previous Application Made: Yes ❑ 'No Rg'New Construction: Yes no ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i '1 Septic nk: Distance from nearest well +_Dista/`n''ce from fou ation_ 0--_-_-__--_.Material___________________________.________.__._____- No.�of compartm 1 4s______._ '"--------Size--T _��_Y .___Liquid depth_c�k_iT _._____-_Capacity_,9__7.49-.--.__ Disposal Field: � Distance from nEarest,welL-,�3�'�'_''�aDistance'from:foundafio -- {_ __..______.Distance to nearest lot line___ ____________ � Number of lines___. -___________________Len nth of each line______ 6_ ___.______..Width of trench ri. g F------------------- =Type or filter materral__f19-z_A------Depth off filter -------------Total length---f-----_____________________________ �1 Seepage Pit: Distance to nearest well----------------------Distance'from foundation-__-----___-_-____..Distance to nearest lot line-------------- ❑ Number of pits---------------- __--Lining material-----------------------Size: Diameter-----------------------Depth--------------.-----------I------ Cesspool: Distance from nearest well-----------------Distance from foundation---____-------------Lining material--------------------------------------- El Size: Diameter--------------------------------------Depth--------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------- ---------------------Distance from nearest building-------------------------------------------- El Distance to nearest lot line------------------------------------------------ - ` Remodeling and/or repairing (describe):------------------------------------------------------------------------------------r----------- -------------------------------------------------------- --------------------------------------------------------------------- ---------=----------------------------------------------------------------------•------••-------•---•-------------------------------------------•---•----------------------------------------------------------------------- ------------ ------- ---------------- ---- --- - ---- ------------------ -re'---- - ---- --•---------------•-------------------------------------------------------------------------------•-------------------------------- 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 and regulations of the San Joaquin Local Health District. K li�(Signed)----- ' t------- --� -------------- --- -------------------------------------------------=-------------------------(Owner and/or Contracr) By: (Title)_ 1 (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----G - - ---- - -- - ------ ------ ---------------------------------------- DATE -- - - ; REVIEWEDBY------------------------------------------- - - --- --------------------------------•-------------- --- DATE-- BUILDINGPERMIT ISSUED---------------- ----------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations --------- --•-- - -Alterations and/or recommendations:-----------------------------------------------------------------------------------------------------•------------..-..-----------•--------------------------- ----------- --••--••-----------•--------------------•--------------------------------------------------------------------------------.....-----------------------••-•-•--•----------------•--•--.----------------------------- ------------------ ------------------•-•------------ ----------------------------- -------------------------------------•---------------------------------------...-------------------------------------- ------------------------------ ---- •------ -• --------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- ---------------------- --------- ---------------------------------------------------------------------•---------------------- FINAL INSPECTION BY:----- -- ------------------------- -- Date-_. ----2--------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100