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•X^ .=r - ?,� APPLICATION FOR SANITATION PERMIT Permit No. 36... •••• (Complete in Duplicate) Date Issued _Vt_ -; q ATJ1Appli ation is hebyma a to thoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance Np. 549. JOB ADDRESS AND LOCATION.. ----- - ------------------- ----�------------------------- Ae Owner's Name.- =Y --•---- --- -------------- e.. -- "_------••-•----- ------ ----- - -------------------------------------- Phone---- ------ -------- Address................ - ------------------------------------ ------------•------------------•------------ Contractor's Name.--- ..... Phone. Installation will serve: Residence Xoo�kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 3 Number of living units: ________ ber of bedroom,____ Number of baths_____ Lot size ___ --x---�f --------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table . -_ ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel 171Sandy Loam El Clay Loam ❑ Clay E] Adobe❑ Hardpan F]Previous Application Made: Yes E] No New Construction: Yes 09'No ❑ 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______________ Distance from foundation__._a----------- .MaleriaL ____________ ___ ____ ________ -- No. of compartments________-11, ._/_Q.y Liquid depth_ - --------=Capacify. _. a� Disposal Field: Distance from nearest weli_� (_Distance from foundation, ------__.__Distance to nearest lot Number of lines______________ _______ ____ Length of each line--------- ,r Width of trench_ ----t---------_-.._ W r -- Type of filter material_,. _____Depth of filter material--/ _______.___-._Total length_ _________________________________-� I .e-1 Seepage Pit: Distance to nearest well_____________________Distance from foundation_____.______...__..Distance to nearest lot ine-------.--------- ❑ Number of pits------------------ Lining material-----------------------S:ze: Diameter-----------------------Depth_.------------------------------- Cesspool: + Distance from nearest well_____ _:}________Distance from foundation___._______________Lining material-____.._.__.__.______________._---__. ❑ Size: Diameter-------------- -----------------Depth------------------------------------- -------Liquid Capacity- .------------------------gals. Privy: Distance from nearest yell________'__ t--------------------------------Distance from nearest building________--__.________-__----.---------- ❑ Distance to nearest loti line--- ------------------------ Remodeling and/or repairing (describe):---- --..--- ----------------•-------- --• ---------------•---------------••-------••-------•-•-------------•-------------•--------•--------•----------------- ---- ------- ------•--•------•--------------------•-----------------------------------------•-------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,.State lays, and rules and regulations of the San JoaW Local Health District. (Signed) --- '¢ -------------------------(Owner and/or Contractor) B .-'--------- ---- 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 DATE__._ _. APPLICATION ACCEPTED BY - - ( -------------------- - BY DATE_. BUILDING PERMIT ISSUED----- DATE ----------------------------------------------------------------------------------------- •------------H-------�- Alfieraions and../or recommendations ---- X---, •- ---y�`-��.... ---- ---•-_=`---•---�--t�------•+-�r--------•-:� -• -------------------------- �►E} X _3 -7- ,d �" – - -------- - ..•�.-+,Ea4 - .-- S.I �/ '� __ -----------------------------------•--------- --------•-----------I--------------------------•----------- --------- v Y FINAL INSPECTION BY:.---------- ti ------ Date.----11---------- � - ------------------------------------ t SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi. California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100