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APPLICATION FOR SANITATION PERMIT Permit No. _� ___ ___ (Complete in Duplicate) r� ' Date Issued Application 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. oczv C,_rm S T— * c JOB ADDRESS AND OCATION__ __ ,c+_t__ --_ -- --__ r- O � Owner's Name L ----------------------------------------------- Phone Address--------- ------- Contractor's Name------------------- -- --- - - ------------- Phone----------------------------------- Installation will serve: Residence artment House ❑ Commerci ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j____ Number of bedrooms Number of baths ___/__ Lot size ___ -a0-X---3-5- --------------------- Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table ----- __- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 1W Hardpan ❑ Previous Application Made: Yes ❑ No 136 New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seIer is available within 200 feet.) Septic Tank: Distance from nearest well A_j ___ _ __lDistance from foundation____,�_�___-_.Mater; ___�i_ _ ------- No. of compartments-----------`,�_-_---Size-------�__�_,�1c� Liquid d th CapacitY !�_[a- Disposal Field: Distance from nearest well----1_15Q-Distance from foundation__�__�____ _Distance to nearest lot in Number of lines___________ ____ Length of each line_________ _ idth of trench_-_�-- �'33 �� _ } 0-0---7�� ---- Type of fitter material____5__ akDepth of filter material______1__ __________Total length------1_ '` - -------- Seepage Pit: Distance to nearest weii----------------------Distance from foundation__ __________________Distance to nearest lot line_______________ iC t ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------------- Depth--------------------------------- Cesspool: -----------_- ------------------Cesspool: Distance from nearest well-________-______Distance from foundation--------------------Lining material-----------------------------------__. ❑ Size: Diameter--------•------r---------------------Depth---------------------------------------------------Liquid Capacity--------------------------- Privy: Distance from nearest well`_________________________________________,__Distance from nearest building --------------- ,4 El Distance to nearest lot line--------------------------------- -----------�----------------------- -- A---- ----------------------�_��} • ta 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) _:! .�!,. �� (Owner and/or Contractor) 8y:.- +�! , e ,-± l�-z —(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------- � --- -�---------------------------------- BUILDING PERMIT ISSUED--------------------------- ------------------------ DATE-- Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------- ----------- ----------------------------------------------------------------------- -------------------------------------------------------------•----------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- ---------------------------------------- ---------------------------------- ---------------------------------------------- ------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:------ _�' - -- ~�--- ------------- Date-------------f-�-- Z a 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 8-51 Revised W-2100