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, 3 APPLICATION FOR SANITATION PERMIT Permit No. QI (Complefe in Duplicate) �J _ _ s Date lssued�"/-�_0_ r 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 complianceiwifh County Ordinance No. 549, JOBADDRESS AND LOCATION----- 7 a s a�------ � •2 Owner's Name_-------------------------------------� ---------------------- --- -- Phone--- Address "t�-' ►:-19.�je----------------------------------------------- ---•---- ------------------------ Contractor's Name-.-----....... -------•-----pa , a+-fir --- ------------------------------------------------------------ Phone----I.-JC.4-P Installation will serve: Residence J4, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._.Number of bedrooms 3-- Number of baths _ Lot size ------ _.-----.-_.--_ Water Supply: Public system CK.—Community system ❑ Private ❑ Depth to Water Table r9,,f- ft. +- is Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe k Hardpan ❑ Previous Application Made: Yes ❑ No-23— New Construction: Yes ❑ No ❑ Pf��i�+pi��i /9-)4:: if t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se_j�#ic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material __--__.________._______._____.___..___-___-____. No. of compartments--------------------------Size-----_---•------- -----Liquid dep h----------•-----_- ------Capacity----------------------• �[ Disposal Field: Distance from nearest well-----------------Distance from foundation------------ -__ Distance to nearest lot line-_____-_---.--- ` r7� Number oz lines-----------------------------------Length of each line-----------------.------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material .-._._.--------------Total length_-_-_----_---------_----:___---_----_--_-. Seepage Pit: Distance to nearest well-0p_ALa__---Distance fromfoundation__f D}stpnce to nearest lot line_-- �_r Number of pits___ ___________ __Lining material-__�C`- •}_�( Size: Diameter___.,--------_--.. Depth_�..`._----.___--.__.______ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_.__---._..--_._-_-._-___-__--------. -- ❑_ _Size: Diameter----•-- -------------------------•----Doth------ •---------------•--------------------------Liquid Capacity-- ------------------------ga's �-4 Privy: Distance from nearest well---------------- ------------- ------------------Distance from nearest building---------------------------------..----.- ❑ Distance to nearest lot line- ------ ---------------------------------------------------•--•••--•----------------------------------------------------------------------- Remodelingand/or repairing (describe):----------------------------•--------------------•--•----•---------------------------------------------•------------------------------------------------ 1 ---•-----------------•----------------------•---•-----------•----------------------------------••------•---------------------------------- ------------------------------------------------------------------------- t -------------------------------------------•------------- -------.f-----••-•---------•----=-----------------------•--------------------------•----•------------•------!=------------------ •--------------------- --' Ilk. I here6y ce i that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfat I s, and rule nd regulations of the San Joaquin Local Health Districf- (Signed)--•---•----- - -- --------------- - ---- ------- ----- - Contractor) - ---- ----------- ------------------------- Title Y:-----------------------------•-•--•---•-•-•.... ----- -- ------- ------------------ ( ) .��x<-_ � - (Plot plan, showing size of lot, location'of system i elation to wells, building etc., can be placed on reverse side). k i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ _ DATE-_._-�__--___. :-- REVIEWED BY ------- ---- - BUILDING PERMIT ISSUED _ __ DATE- _7 �.. ----- ----------------- --------- ------ --------- ------------------•----•--------------•----------------------------------------- DATE------- -- Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------------------- ---------•------------- ------------------------------------------------•-----------------•---------------------••----------------- -•------------------------------- ---------------------------------........---------•--------------------------- -----------------------------------•----------•-------------------=-------------------------------------------------------------------------------•-----------------------------------�------------------------------•-------- ------------------------------------- ------------•------••---------- --------------------------- --•-•---•---------•------------------------------ -------- •----------------------------------------• ------------- FINAL INSPECTION BY:. /� A' "' 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 10.52 Revised W-2140