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"? APPLICATION FOR SANITATION PERMIT Permit No.3.____._ Ik / (Complete in Duplicate) Date Issued_'_______` Applica�ion is hereby made to the San Joaquin Local Health District for a permit to cinstrucf a 'stall the work herein described. This application is made in compliance with County Ordinance No. 549. s�+� JOB ADDRESS AND LOCA ION -------- 1 / -------------------------------- Owner's Name -1 -7---------------------------------------- Phon ��_�!_-1_L-- Address__--------- Q 1__ .. `-."-..� --------------- ----------1--., - Contractor's Name---- .. —-------------------------- ------ Phon _ _ / � Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 2" Cher ❑ Number of living units: AV Number of bedrooms a -o,_ Number of baths s2/ Lot size _14-4_- ---_____________________ Water Supply: Public system ❑ Community system ❑ Private Z -"'Depth to Water Table -,0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan F1 Previous Application Made: Yes ❑ No UK' -New Construction: Yes &<o ❑ 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__ ___ iDistance from fo-_p.ridation---- 14_. ----- .M tera_l___c.___-- No. of compartments _____.__--- Size_41yAZd--------- Liquid depth ---- �!_±----------- Capacity -v_Z_®_D4 r Disposal .Field: Distance from nearest well__�._Distance from foundation-__ -------- Distance to nearest lot line.--_�4 -___-_ jy. Number of lines ----------- ----_.__ Length of each line—A90!'=��6__��.Width of trench -------- ____________________ Type or filter materialb_2.-V-t—_____Depth of filter material ----- length0_____________________ Seepage, Pit: Distance to nearest well ----- ------ Distance from foundation__.-%.-3-0__.___Distanc a to nearest lot line ---- . Number of pits ------ ---__�✓-Lining material_�rl L�'`-Size: Diameter ----- --�_ Depth ..... 4----------------- 04 Cesspool: Distance from nearest well----------------- Distance from foundation -------------------- Lining material -------------------- .___-__-_-_._____ 6 ❑ Size: Diameter -------------------------------------- Depth ----------------------------- ------ - -------------Liquid Capacity ---------------------------- gals. S Privy: Distance from nearest well-__._____________ ____________________________Distance from nearest building ----------------------------------------- nDistance to nearest lot line ----------------------------------------------- ••--------------------- •------------------------------------------------------------------ y Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------- -..----------------------- -- C -------------------------- ------------------------------------- ....------------------ --------------------- --- •--•----------------•-•-----•-----------------------------------....---------------------------------------- L ----------------------------------------------------------------------------------------------------------------------------------------------•-------------------------.---------------------------------------------------0� -----------••-•------------•-------------------•-------------•------------------------•-------------------------------------------------------------------------------------------..-.-----..--------------------------------- I hereby certify that 1 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. (Signed) ------------------------------------------------------------------------- r 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- ------------------ --------------------------------- =__.---------------------------- DATE9� -------------------------------- ----------------- REVIEWEDBY-------------------------- ------ ---- --------------------------- ------------------------------------------------------- DATE ---QM ------------------------------------------------ BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------------------ DATE-------- - --------------------------------------------- Alterationsand/or recommendations:------------------------------------------------------------------------------------------------------- .----------------------------------------------------- ------------------------------- ------ ----------------------------------------------------------------- ------ ------------------------------------------------------------------------------------------------- - -------------` rf--•------------------------------ ----------- Date FINAL INSPECTION BY:.--------- {---------------------------------------------- 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 ; - Revised W-2100