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c� APPLICATION FOR SANITATION PERMIT Permit No. ........................ (Complete in Duplicate) Date Issued ._�_ _I.c .._.� i- Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application n cliance wld County Ordinance No. 549. JOB ADDRESS LOCA 10 ---- -- ---- ---- -- ---- ---------------------- Owner's �------ ... Phone.--- -- - Owner's Name.... ��- C—_---------- , ----------••--------------------- -------- --- ----------------------- ------------ ----•---••----- Address-------lv-� -f---j - �- -- -=----------- ----------•----------------------------------------------------------------•-----••---..----------------------- Contractor's Name-------- ----- --- '--------------------------------------- •----------------------- Phone----------------------------------- Installation will serve: Residence 12 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�__ Number of bedrooms _,;-Number of baths .__I-- Lot size _________________.______.__._ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table 412 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ZL Hardpan ❑ Previous Application Made: Yes ❑ No tig— New Construction: Yes ® No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well_.1��_ir?'�yDistance from foundation---- Material._��C-. ' ' & No. of compartments------Z---------------Size---k-5Z--- $-4---Liquid depth____/,t_Q--------------Capacity____.F—-------- Disposal Field: Distance from nearest well../V-d2-LAZDistance from foundation___ _ a__.._....Distance to nearest lot lin t�_.l.d_�__. ' Number of lines.--.-•------f',--LL-._'f--.-.----._Lang#h of each line-------- ----- �__.-.Width of trench-._-2,41 Type of filter material___ A......Jr___�Depth of filter material_____�_g-----------Total length------so---------------------------- Seepage Pit: Distance to nearest welL.A/ ..-Distance from fourkdation___"____.Distance to nearest lot iine_1_6_l Number of pits.....1___ __________Lining material, .__-_ IQe: Dia meter__...Z_ ______.�- Depth_-..r�.._a_j_-------------•--- Cesspool: Distance from nearest well-----------------Distance from foundation------------------..Lining material----------------------------------- __ ❑ Size: Diameter------------------------------ -------Depth----------- --------------------- -----------------Liquid Capacity------------------ -------gals. Privy: Distance from nearest well---------------------------_______-------------__Distance from nearest building-----.------------------------------------ -_ ❑ Distance to nearest lot line---------_---------------------------------- __ w Remodelingand/or repairing {describe)---------- ---------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- --------------•------------------------•-- ------------------------------------•------------•-------------------------------------------•-•------------------------•-------------•------------------------------------------ I hereby certi that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staf a , and rules and regulations of the San Joaquin Local Health District. (Signed)................• --- --- ---------------------- - ---- -- -----•-------- -------------------------------• Owner and/or Contractor) By:...... y�� -----------•--•--------•-------------------(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--------- ----------- --- ------------- - --------------- REVIEWED BY---------------------------------- DATE---------------- -------- ------ --------------- A -BUILDING PERMIT ISSUED DTE-------------------- -- Alterations and/or recommendations:------------- ----------------•-•-•--------------------------------------------------- -- 16- -e----------------------- -- ------- �-. -•---------------------------------------- -------------------------------------- ----------- 9 FINAL INSPECTION BY:..--- --------. Date ` `1 �p 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 145446 ATWO6D