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�►1N`� APPLICATION FOR-SANITATION PERMIT Permit Wo. ..... 3_ (Complete in Duplicate) �t . 3 Date Issued 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 is made in compliance with County Ordinance No. 549. JOB ADDRESS AND. L C TION------ / ��----- A16 - --------- ----------------------------------------------------------------------------------- 114 Owner's Name------ ------- --------- l ._!t-� .�t l_ .�. Phone ------------- Address-------- ---- "+- "' Contractor's Name .... ------. ` [3-, .->ra ------- hone_ ~9 1 Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /--__ Number of bedrooms _.,;?___ Number of baths -1----- Lot size ----TS✓-.x --____________-____ Water Supply: Public system $0 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [A Hardpan ❑ Previous Application Made: Yes ❑ No Q! New Construction: Yes Dk No ❑ a 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-----A7 Material._ e ----.______- P --------Size---.--•----_4.3.6--------Liquid depth------------- - --- Capacity No. of compartments �G _____.Ca acit ____9Z� Disposal Field: Distance from nearest well_................Distance from foundation_----- 3____-_-.Distance to nearest lot line---Ld----_-___ Number of lines______________� Len fh of each line------- //.��______� .Width of trench _Y_�.---_-__._____-___-_ - -- Type or filter material--/25-__.ITn_ epth of filter material_-_..f-. __...."___._Total length---------14__........F_______________ Seepage Pit: Distance to nearest well.__- ti _Distance from foundation____-_�_-'�___,-_.Distance to nearest lot line------If--I_-- f Number of pits-------- material_�4-.�k--._-_&ze: Diameter___.53.�____. _l 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 building__ __---__-.__.__-__-_.._-_____._. ❑ 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 laws,:and rules and regulations of the San Joaquin Local Health District. (Signed)------�' `'1 ' --- -'��} '` �-- ----------------------- (Owner and/or Contractor( y< ------------(Title}_------` --•----------------- --------------- By------------------ - r �-----fes- � � �'� " (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. = REVIEWEDBY--------------------------------------------------- -------- -----------------------------------_--•-------------------- DATE---------------� � _. v`-- BUILDING. PERMIT ISSUED--------------_------------ ------- - DATE------------------------ •----- Alterations and/or recommendations ------------------------------------ 1 ---------------------------------------------------------------------------------------------------- -----------------------------------------------------------------••-------•------------------------ - ----------------------------------------------------------- --------------------------------------------- _------------------- --------'-----------------w------ " ------ ----------------------------- -�SPFINALINCTION BY: ----------- Date----.-. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100'