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APPLICATION FOR SANITATION PERMIT Permit No. ------- " (Complete in Duplicate) � Date Issued 3 o a -3`z- Application is hereby made to the San Joaquin Local Health District for a permit to construcand install the work herein described. ['( This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATi N -- � r hf Owner's Name------ ------------ ._ yE-' '� r------------ ---------------- Phone------- Address-----------------------------------------------------------�It - - - Contractor's Name-------------------------®.--------- ----•-•---------------0-----------------------------------------------------------0--------• Phgne----••---------------------------- Installation will serve: Residence Apartment House Commercial A Trailer Court Mo,;Ir Other Number of living units: _1-___ Number of bedrooms __. _ Number of baths ___3_ Lot size ________Rh_____ ________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ff.0, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobep Hardpan ❑ Previous Application Made: Yes No)j . New Construction: Yes No KI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200.feef.)-- 46 1 Septic Tank: Distance from nearest.wellik*_470---Distances from foundation__1A_..________.Material--- --____________________. 0 . No. of compartments-----------�-_________Size__�1 _F Liquid depth__-2.°�___________Capacity_/-1_4C!""-.__ Disposal Field: Distance from nearest well_��kp Distant ro mfoundation---4i-________Distance to nearest lot lineJ_--A______- I. Number of lines-----------------------------------Len th of each line___.. _ � �__________ Z __ -------- Type --------De Length of filter material 1--- ------------=otalthlength--Z-1-3nC __-----,�_�_--- 4 Type of filter ma#erial_��l�w p � 1 Seepage,Pit: ~ v�Distance;ta nearest well _4 � Distance fro fo ation _ - "Distance to,nearest lot.�ine- - e Nbmber of its -------- .-Lining material_S ie Bilzer_� :__:* _.D6pt --------------------------...___- Cesspool: Distance from nearest well_______ _________Distance from foundation _-----------�_ _..Lining material------------------------------------- 171 -________________________..___._- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. "—JL) Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____________--_______:___________________.---� ❑ Distance to nearest lot line--------------------- ---- ------------------------------------------------------•---------------------------------------- R odel'nq and/or repairing (describe)- 4w - - ----- ---- -- - ----------------- •----------------• ---•-•- I _ ¢.. ,_ ----------- -- - ------------------------------------------------------- ------------------------------------------------------- I hereby certify that I have prepared this a �Iica ion 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)-- �� i� ------------------ ---------------------------------------------------------------------(Owner and/or Contractor By ---- ------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, eft., can be placed on reverse side). I! FOR DEPARTMENT USE ONLY APPLICA 71 ON ACCEPTED BY------------- -- - ------ - ------ ------- -------------:-------------------------- DATE-------- }-------- REVIEWEDBY----------------------------------------- - --------------------------------------------------------- DATE----//'-- BUILDING BUILDING PERMIT ISSUED------------- ----------------------f--------------------------------------------------------------- DATE---------------- ------------------ ------------------- Alterat'sons and/or recommenclatons:-.------------ -------------------------------- --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------- ---------------- ----------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------I-------- ------- -- ---------------------------------------------------------------.--------- -------------------------------------------------------------------------------- ------ ---------------------------- ------------------------------------------------------------ 2 FINAL INSPECTION BY----------------- - __ � "_-' A____, � Date_ ----- �T 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 4