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. It APPLICATION FOR SANITATION PERMIT Permit No. - f ---- (complete in Duplicate) - lDu p p ) Date Issued -------- /•� work herein describe Apthe is hereby made to the San Joaquin Local Health District for a permit to construct and install he This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATION-----seta =------ C. f OwnEr's Name Phone Address --------------------------------------------------------------------•-----------•------------------------------- -------------- ------------ Contractor's Name-----------a"La'Ir -° -------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: )------- Number of bedrooms ---{.--. Number of baths I----- Lot size ----------�i_--� - -- ------- 11 iv Water Supply: Public system ❑, Community system E] Private �h to Water Table __-----_ ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous AppfEcation Made: Yes E] No T-1NewConstruction: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well_________________Distance from foundation--------------------Material-------.________------___ ____-______._____----- No. of compartments------ ------------------Size--------------------------------Liquid depth--------------------------Capacity-----------y'^'-r---- "`� __.Distance to nearest lot line__c.2 Disposal Field: Distance from nearest w tl ______Distance from foundation _�_� Number of lines------------------------------------- - Length of each line______(g_�____1__------Width of trench__ ___�� Type of filter material... _._Depth of filter material-------)_F--_______Total length------ ---------------- LA Seepage Pit: Distance to nearest well----------_-----------Distance from foundation--------------------Distance to nearest lot line------------------ Number of. :ts --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 buil,ding---__________--____________-------------- ❑ d - 'Distance #d nearest-lot'line-------------------------------------------------------------------------------------------------------------------------- -+G ' r Remodelingand/or repairing (describe)-------------------------------------------------------------------------•-•-------------------------------------------•--------------------------------- ------------- ----- _..-•---- - - of 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. ��+ . -----------(Owner and/or Contractor) (Signed)--------------------------------------- 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-------- it .., REVIEWEDBY--------------------------- -------------------------------------------_------------------------------- --------- DATE------------------------------------------------------------ BUILDINGPERMIT €SSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------ ------------------ Alterationsand/or recommendations-------------- -------------_-------- ------- ----------------------------------------------------------------------------------------------------------- - - . __ --- ------------ ------ Date- --------\77.\�- ----------- --------------- FINAL INSPECTION BY:----------'.----- ------_---- SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street ` 300 West Oak Street 132 Sycamore Street $14 Nor+h "C" Street Stockton, California Lodi, California Manteca, California Tracy, California L ES----9-2M 8-51 Revised W-2400