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1 ' APPLICATION FOR SANITATION PERMIT Permit No111-77 e- -� 34 Date ate Issued t (Complete in Duplicate) 7 / A ication is heF 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, JOB ADDRESS LOC TION + --------------------------------------------------- ------------------------ ' ' Phone--- -- d-7�L_�- Owners Phone---/----------------------- Contractor's Name---------. ..installation will serve: Residence Apartment House ElCommercial E] Trailer Court El Motel `s❑ Other E] I ----------------------- Number of living units:!-__-__ Number of bedrooms .-3-- Number of baths __1 tot size 7 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 3.7ft. Adobe' Hardpan ❑ Character of soil to a depth of 3 feet: Sand [_1 Gravel ❑ Sandy Loam ElClay Loam ElClay ❑ Previous Application Made: Yes E] No New Construction: Yes No El 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___r_�_-----------Distance from foundation ---------- ..Mater---- --'------ No. of compartments---------'RP•-----------size.S�_I�ya--X -- Liquid depth------ _.8---------Capacity--- -y Y 0-�-"__.Distance to nearest lot he__1, -_.- Disposal Field: Distance from nearest well__________________Distance from foundation___ i Number or' lines-----------1___.-__"_----- ----Length of each line------. -Q- ----'-------Width of trench..- .`'�---------------------- T .r i ' •- -"_i7e Depth of filter material---'--��---------_dotal length-------- _-� --------------------- Type --- ------------ Type of filter material"S,._�d'r.�- p � Seepa a Pit: Distance to nearest we11_______________---"__Distance from fo dot ion Distance to nearest lot li-`�S-i Number of pits:_-_A/----------Lining material_Sc_Ru _.Size: Diameter__.---�-�r__--'-'--Deptn....__ 4i--------------- -'- 1 Cesspool: Distance from nearest'welL_____--________Distance from foundation.____._-..____.__- Lining material__._______ ----- -- Size: Diameter" -- -----De th----=---------------•-------------------------------Liquid Capacity- - ---- -------------- ----gals. ❑ _._._Distance from nearest building------._""__---------------------------- ' .- Distance from nearest we ____----------------- ---- �..Privy: ,, _ �.� _ _ • -- �.. = ---'-------------------- --1 _ � < ❑ Distance to nearesYlot =-= -- - = r Remodeling 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. t a Owner and/or Contractor} Si ned -------- - -- ----- " (Title}_ _ 63�4 - -- ------------ -- By----••--------- • •- - - (Plot plan, showing size of lot, location of syst . in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY = =--------------------- DATE- r- -------- -- - - ' APPLICATION ACCEPTED BY------------ -----' DATE-----------------•------ REVIEWEDBY--------------------------------------------------------------------------------- ---------------------------------------- BUILDINGPERMIT ISSUED------------------------------- - ------------------------- DATE--------------------------------- --------------------------- Alterations and/or recommendations------------------- ----- --------------------------- _---- - r ----- ------------------------------------------------------------- g ------------- FINAL INSPECTION BY:-_-------- ' Date- ----------------- _ M SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132-Sycamore Sfroot 914 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. ES-9-2M io-s2 Revised W2100 �`