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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) " C_ Date Issued 5-53 o Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t This application is made in compliance with County Ordinance No. 549, erein described. ---- ----•- ` ---- .._. _ odycto_J•+ ` GJ ---JOB ADDRESS AND LOCATION__: _ p Owner's Name---- ------ ------------ - --.--------- ------- ------------- -------------- --- -- - -- - - - --------- Address--- j A �y1h-------------- --------------•--------- Contractor's Name-------0_w h_�h c�9* -------------- Phone---- --------- Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �?,__ Number of bedrooms __3____ Number of baths _Z_. Lot size Water Supply: Public system ❑ Community system ❑ Private 14 Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑' Adobe, Hardpan ❑ Previous Application Made: Yes Q No ❑ New Construction: Yes M No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.} 1 t. pt c-7 Distance from nearest well_________________Distance from foundation-------------------Material-_- No. of compartments------------ -------------Size--•-----------------------------Liquid depth--------------------------Capacity----------------------- - + s Disposal Field: Distance from nearest well-__ v0-____-Distance from foundation-_-J-U_------_.Distance to nearest lot Number of lines---------3_>--------------------Length of each line& -.��.. r_._.Width of trench_ -.2-9 Type 9Type of filter material-511-&-c-17%------Depth of filter material-_---1!_ ------._Total length--------- _o-r--�_ - --------------- ------------------•---- Seepage Pit: Distance to'nearest wel!----------------------Distance from foundation__-_-______-_____ Distance to nearest lot line.......... f El Number of pits----------------------Lining material-----------------------Size: Diameter------------- --------Depth------------ -----------______- ---=" Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material Size: Diameter__ Depth----- ----------------------------------------------Liquid Capacity...•-----------------------gals, Privy: Distance from nearest well-------- -----------------------------------------Distance from nearest buiidin g ❑ Distance to nearest lot line-------------------------------------------------------- ---- ' Remodeling and/or repairing (describe):---------------------------------------------------------•-----•-•------ --•---------------•----------------- ------------------ ---------------------------------------------- ---------------------------------------------------------------------------------------------------------•---•--------- ---------•---------------------------------------•--------•---------------------------------- ------ { 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�rA and rllule regulations of the San Joaquin Local Health District. ' ,•4 ! { (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------- ---------- --------- - © DATE-.---//---------TZ -,� ------------- REVIEWED BY --------------- ----------- - ---.-------------------_ - DATE BUILDING ------------------------ PERMIT ISSUED------------------------------------------- --------------------- DATE----- ------------------------------------ Alterations and/or recommendations___ ----- ----- ---7:-----.S :.:---------- _ 7 - -------- - ---------- -------------------------I•--------------------------- - ------------------------------ ---- - FINAL INSPECTION BY:,--- % _,1_5------------------------ ------------- Date------ 7771_4-----� 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 io-52 Revised W-2100