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6 CPO . y - �,,, APPLICATION FOR SANITATION PERMIT Permit Na. _________________ N (Complete in Duplicate) Date Issued j1-10_" 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. JOB ADDRESS AND LOCATION-3-7.31----SaV_ - S .p_ - '----- ` Owner's Name-------- 1^S:__ 'ac- �� _d!! 1��"---------+--------------------- ---------- ---- - ----------------- �Phcll---�_e�.��_�.------- - t Address.... Contractor's Name-------------------------------------•------------------------------------------------------------------------------------------------------- Phone-------.._------------------------- Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---V_ Number of bedrooms _ _ Number of baths _f____ Lot size ___ . -----: ----. oe________..____ Water Supply: Public system IN Community system ❑ r Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet:` Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 14 New Construction: Yes 0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)t Septic Tank: Distance from nearest we L /0 h_ .DistaQ e frorrp foundation__._d________-Mat�erial___C ��_____ ------------ 1 No. of compartments------- -- . 5ize x`°� ` Liquid depth Capacity C Disposal Field: Distance from nearest we11. 0-he_..Distance from foundation---/V-----------Distance to nearest lot line__._________- Number of lines_----_--�-------------------Lengtl- of each line----"_6. 0-rs--- -__.---.Width of trench.----z-_Sf_"-------------.--- Type or filter material__ off_ _--_-:-_Depth of filter material_-I ______________Total length-------- L.P_'.___________.__.._ Seepage Pit: Distance to nearest well------ ______--------Distance from foundation-------.----------- Distance to nearest lot line----------------- ❑ Number of pits---------------------Lining material----.._------ Size: Diameter-----------------------Depth-------.---------------------- Cesspool: Distance from nearest well_______'____-_Distance from foundation--------------------Lining material______.______________________________ ❑ Size: Diameter------------------- ------------------Depfh --'----------------------------- ------------------Liquid Capacity----------------------------gals, ' Privy:`" Distance from nearest well------------------------------ - __ _ _:..=______-__._Distance from nearest building - 1 ❑ g-•-------------- --- -- ----- Distance'to nearest lot line------------- ----- -- -=------------------------•------------•----- ----------- Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------------- d: ----------------------------------------------------------.-------. _ __ ------------------------` ---------- --------------••---••--------------------------------------------------------•-- ---------------------•------. .._ ------------------------- 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. . (Sig nedl_-�,(�,W.-_ (/ � -'�/. � --------- -- -------------------r -- •--------------------------- - -----`=---�--------=---------------------- ----- - ------ ----(Owner 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------- ---- --- -r__ - ----"- ------ -a--- --- ----------- DATE----_j/r.I REVIEWEDBY------------------------------------------------------------- --------------------------- -------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------- DATE------------------------------------ ferafions and/or recommendations------------------ ��---- �r� j -------------- - ----------- ----- ------- ---------/yv-----------�t�el--------- orf / ----- �N -------------;------- lC. -----------' 61.-------------• !�33--------- �7 rf �r ------- � �?.� ftee -- -- / 'j---------------------------------- r FINAL INSPECTION BY:---------- ------- I& - ------------------------------- 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 I0-52 Revised W-2100