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APPLICATION FOR SANITATION PERMIT Permit No. ---___- 1 6ry (Complete in Duplicate) Date Issued j a- Appl cation is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s bed. This.a.pplicatign--is.made-1n^compliance with County Ordinance No. 549. .JOB ADDRESS AND QN ------- -- - - ` -- -9------ - -- --------- ------------------------ Owner'sF� N - • _, _+ � r ----------------------------------------------------------------- Phone---- _7SF l Address-_----------------------------- �< r _ ��7`�f_C .- • - - - -Contractor's Name---- - - A4 SAN-6 ---------------- -----� . Phone--- Installation Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel " Other ❑ Number of living units: J-7--- Number of bedrooms __�_'___ N.umber of baths J_�__ Lot size -----------------------••------- Water Supply: Public system ❑ Community system '❑ Private J9 Depth to Water Table }z�A_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ElPrevious Application Made: Yes E] No J& New Construction: Yes ElNo JK 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----------------------- Disposal Field: Distance from nearest well------------------Distance from foundation---------------------Distance to nearest lot line----------------- F1 __- _____._-_❑ Number of lines-----------------------------------Length of each line------- -------------------.Width of trench----- Type of filter material____________________._-Depth of filter material-__.__-.-_____________Total length_______-.--______._--___ i i � Seepage Pit: Distance to nearest well__//Q______-_._.._Distance from foundation__-- ________��ance to nearest lot line__/40_____. Number'of pits__U�L e---------Lining material_$1Q-t_C-f /----Size: Diameter------------------------Depth___r�,t '-__ ---------_ M � Cesspool: Distance from-nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- _ { ❑ Size: Diameter ----------Depth----------------------------------------------------Liquid Capacity - gals. ! Privy: Distance from nearesF well------------------ _______________________Distance from nearest building----------------------------------------- - ❑ Distance to nearest lot line---- ---------------------------- -------------•----------------------------------------------- Remodeling and/or repairing (describe):_-__.___ — t k+ - ---------------__�________ _ ------------r�------ J---------- - - -- --------------•----------------------------...-----------------------------...----_--- ---------------------------------------------------------- ------------------------------------------------------------ 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 �gulations of the San Joaquin Local Health District. (Signed) r_-- -- r--- -- Owner aF®rCon,BY:-----•-------------------- --• • r ract or -------------------(Title)----- �Q.! (Piot plan, showing site of lot, location of system in relation �o wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------ - ----- _ DATE = ------- REVIEWED BY - = -------------------------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------'----------------------- DATE--------------------------------- Alterations and/or recommendations:------------------------------------- -----------------------------------------------------------•-- ------------------------------------------------------ - --------------------------------------------- ----------------------------------------------------------------------•------ -----------------•---------------- ----•----------------------------------------------------------------------------------------------- --•- FINAL INSPECTION BY:---- `' ` Date_.._. _ 'S Z-- SAN JOAQUIN LOCAL HEALTH DISTRICT t 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 8-51 Revised W-2100