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FOR SANITATION PERMIT �ermit N . . _��S`f �F (Complete in Duplicate) -- � -3 i 17��e�ls ued a.�-�.( ------- Application is he y 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. -1,01 JOB ADDRESS AND:LOCATION.--Wf? p w----- ! Owner's Name------------•--------- f>.- .-c3 i!' ------------------------------------------- - ------ Phone----•-------- Address--------------------•---•------------------- - ------------------------------------------------------------------------------------------------•--- Contractor's Name------------------------------.--------------------------------------------- --------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence Qj Apartment House Commercial # p ❑ ❑ .Trailer Court-[—] Motel [-I Other ❑ .' Number of living units: -------- Number of bedrooms _X_ Number-of baths ----t--_ Lot'Size --____---------.--- Water Supply: Public system, Community system E] Private ❑' Depth to Water Table`_- :_ __ ft. _ Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑"Clay Loam ❑ r Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ALNo New'Construction: Yes No ❑ 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 _--UXt---Distance from foundation------W-_------Material--------- No. of compartments-----------2,------4----Size.....,/-q-4.6 '_ --Liquid depth----------Y1-�-:-_------Capacity-------k_4�70_-9 �. Disposal Field: Distance from nearest well.-----)'4f7------Distance from foundation------?0-_- Distance to nearest lot line----�----..._-- Number of lines-__......___ ._____-______'_Length of each line----- �_-'xtl_' _Width Width of trench---------)_y_��.-__--_____-__- Type of filter material------j_�k}-_ ------_Depth of filter material ---_--_-1_�'._---__-Total length-----------j-)AP_j------------------ Seepage Pit: Distance to neares well--_------------------Distance from foundation-------------------Distance to nearest lot line_-.-----------.-_ ❑ Number of pits----------------------Lining material-.---------------------Size: Diameter-----_----------_--__--Depth--------------,--____-- . --------- 1 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----------------------------- a - --------------------------------- y Remodeling and/or repairing (describe)---------------------------------------------------•-_-- --- �� ------------------------- -------•-----------------------•----------------•------- ---------I---------------•---------- G t ------------ ---------- -------------••----------------------------•----------------------- --------------- - --`---•---------------- -------------------------------------------------------------=- I hereby certify that�I hav prepared this application and'that the work will be done in accordance with San Joaquin County ordinances, Sf.Afe laws, d ru s and regulations of the San Joaquin Local Health District. {Signed} - --------------------------------------------------------- ---------------------------------- ------(Owner and/or Contractor) By----- --- ----------t---.--------------------------------------- ------------------------------------------------------(Title)------------------------------ ------ (Plot plan, sh ing 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 ,::--5------------------------------ DATE REVIEWED $Y ��--------------------------------------------------------------------------------- DATE----------- BUILDING PERMIT ISSUED-------------------------=-------------------------------------------------------------:_----------- DATE = Alterations and/or recommendations:__r------------------------------- ---- ------------------------ ---------------------•-------------------------------------------------- -• --------- ------------------------------------ -- --- .� ,. FINAINSPECTION BY:_ "----------------- --- -- ---- ------------ Date--- L SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100 }