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W. 'APPLICATION FOR SANITATION PERMIT Permit No, �g_�{_7_---____ (Complete in Duplicate) Date Issued i 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 L _ ___- -- ---- -- -- ----------------------- _40N �� f/ • Owner's Name--------------•-- ------- --------- ----- ----------------------------- --------------- ---- Phone - ----- Address-------------------�a��-------- ----------------------------------- -----a Contractor's Name-------- --------------------------------------------------------- ----------------------------------- Phone----------------------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:/---- Number of bedrooms J____ Number of baths I---- Lot size _(_'71�-_-,_1__17P-------------------------- : Water Supply: Public system X 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 or Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: YesV No F-1 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_h __Distae from foundation__/P____:_______.M __ aterial_________________ ! No. of com artments____ _ _________________Size__ _ Disposal Field: Distance from nearest well_��'�t4__Distance from foundation__ __________Distance to nearest lot line---4�___�_______ Number of lines------ .-- ------------------Length of each line__ ` --------Width of trench__-- - . ._ _____.________._ Type of filter material__✓�4�.---_____Depth of filter material_A�-t---------------- length-----------_-_A_____________________ I 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-. ---------------- material_______-----__________________--_____. ❑ Size:' Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_ _____________________________________Distance from nearest building_-__--_____________________--________- t ❑ Distance to nearest lot line------------------------------------------------------------------- ----------------------------------------------------- ------------------ FRemodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- ---•-----------------•------------------------------------------------------------•----------•------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------•---i •-• --------------------_----------------------------------------------------------------------_ ------------------------------------ -----------------`--------------------------------------- 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. �,�C Z�1� {Signed)------4 �_._-----�- --------------.- (Owner and/or Contractor) FBy:--------------------------•----------------------------------------------------------------------------------:---------------------(Title)--------------- ---------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ,c FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ------ �-- --- --- --------. - _ �a. -- -- - DATE--- / ------------------------------- DATE ,, { e;i ------------ REVIEWED BY ' BUILDING PERMIT ISSUED--------- ------------------------------ ----------------------- DATE Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------•------------------------------------ ------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------•--------•----•-------------------------------------------I-------------•---------------------------------------------------------------------------------------•-------•---- ----------------------------------------------------- -----------------------------------------•--------- - ---------------------------------------- ------------------•- --------•- ---------------------------- FINAL INSPECTION BY------------- - ---------------------`----------------------------- Date_ -------- ------ ----------------------- 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