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1 u' - APPLICAtI00 -FOR SANITATION ,Fermi•, ,•7o ------ 5 (Complete in Dup[ica're) 1 4 1 l i I Date Issued r - Applic io is h reby made lo 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 LOCATION. �------�---- --� � (�� Owner's Name --( ----(?*,5 r`O --------------- Address 7wI'hon----------------------------------- - ------------------------------ e� Address---------------------- --------••------••--------------------------------------------------------------- Contractor's Name---------------------- -- -- i -------------------------------------------------•---- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ MotelE]E] ,OtherI Number of living units: I---- Number of bedrooms ________ Number of baths __Z_ Lot size ________/+ o__x_ ____________ Water Supply: Public system Ef Community system ❑ Private ' Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,W Hardpan ❑ Previous Application Made: Yes ❑ NoX New Construction: Yes [?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___`'�__a_-----Distance from oundation_____j_o________Material_______ ---_--------- KNo. of compartments----------v -----Size----. _--Liquid depth------- ---------Capacity----12,-QQ ---- Disposal Field: Distance from nearest well___ Distance from foundation----/Q_f____Distance to nearest lot line_______. �t Number of lines-----____ ____/____---________Length of each line___________1�.5��_______-Width of trench___.--_______��_��-_______ If t Type of filter material_______ __ &-____Depth of fiifer material----------IA_________Total length______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation------------........Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.-----------.----------Depth-------- _-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-_._----------------LLining material ------------------------------------- ❑ - Size: Diameter--------------------------------------Depth-----------•----------------------------- -------- q Capacity _:. ---- .s. Priv Distance from nearest well-________________ _______Distance from nearest building ❑ Distance to nearest lot line------------------------------- -----------------------------------------------------------------------------------------•------------------ Remodelingand/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 laws, and rules and regulations of the San Joaquin Local Health District. (Signed ..., = _�, `---"---0------- -- --- ------------------•---------------------------------------(Owner and/or 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----- REVIEWED BY-------------------------------------- ---------------------------------------------------------- '7f` ---------------------------------------------------------- DATE-------------- --'-'---- - BUILDING PERMIT ISSUED---------------- ---------------------------------------------------------- DATE------------------------------------------------- ------------ Alterations and/or recommendafions:---------- ------------------------ -------------------------------------------------------- -----------•--•------------------------------ -------- ---- ` .. ------------- -----------------------------------------�------ - ----------------------------------------------- - -- -------------- ------------------------------------------ i FINAL INSPECTION BY:--- u -------------------- Date---------��-- --�--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ 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