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''APPLICATION FOR SANITATION PERMIT Permit N (Complete in Duplicate) ---� Date Issue;*- -- 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 ATION__ __-_____ __ �%___------- •_ - .a�.�rrt _ Owner's Name------------ - -----+ -------- - ---- - .r_ ------ Phone---------- -------------- Add ress---------------------- Contractor's Name------------------------- ------ Phone-------------- Installafion will serve: Residence ❑ Apartment House ❑ Commercial E] Trailer CoCourt B---bbl-el—❑"-Other F]Number of living units: _ Nu ber of bedrooms ___Z►1Vu—mber of baths _ "Lot size � --- -----I--- ------------ .Water Supply: Public system Community system El Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam U5—.Qe7 E] Adobe ❑ Hardpan ❑ Previous Application Made: Yes ED,,Nt—ff New Construction: Yes4 lc 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------ ----- -- aterial---------- --------------_---•- ---- No. of compartments------r�_--------j--Size__ __ -, Liquid dep __---..,��___--_-_Capacity__��- ' y Disposal Field: Distance from nearest w -----Distance from foundation___ _ ------Distance to nearest lot line.___ Number it lines--____-al- ---- ------ -- -Length of each line-:-------�--_%_:---.Width of trench-------- Type of filter material_ -�_-_L---� �pepth of filter material---t45------------Total length _ ` 9 --�---- ---- ----------- ---- rel Seepage Pit: Distance to nearest well__--------------____Distance from foundation--------------------Distance to nearest lot line------___-------_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------------- Depth---------_----------------------_ : l Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___----____-____---_____ ------------- ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line Remodeling and/or repairing (describe}--------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------- ------------------ k hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County F ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- -__--� �� ... y_� 'L ! (Owner andlor 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______________________________ DATE- ------- -� 03----47 ---------------------------------- -------�------_ - - REVIEWED BY--------------------------------------------- ----- - ---- DATE -------- - --------------------------------------- ---------BUILDING ISSUED --------------------- ---------- DA JE - Alterations and/or recommendations:--- �� _ _-_ 4 � !„ t ^ ---------•------------------------------------------------------------- ------------------ ---------------------------------------------------- ---------------------------------•-------------------------------- ------------- •-------•-----•-- 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-9-21v1 B-51 Revised W-2100