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X11 APPLICATION FOR SANITATION PERMIT Permit No. , 5 .. 4�� ....l.-7 (Complete in Duplicate) Date Issued Applica;ion 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. 4 JOB ADDRESS AND LOCATION..----�------ ---------------------------- Owner's Name------- /..�~-------------------------------------- Phone- - 8 ----------------- - -- Address-------- _`-�° ...- •-- -••-�------f1- -•- ---- �~ Contractor's Name = Phone ----------------------- Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms.. Number of baths ._/__ Lot size _____ r -- Water Supply: Public system 2--l'Community system ❑ Private ❑ Depth to Water Table3_o_ ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2100* Hardpan ❑ Previous Application Made: Yes ❑ No 9 ---New Construction: Yes ❑ No �J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic T Distance from nearest well_ -Distance from foundation_-_- /Q ---- __---- .Material__ _��_'_.. __ No, of compartments_._____a2: Size__ �� F_�; a Liquid de th___:_'�/ -------- Ca p acit � Disposal, Field: Distance from nearest well?2_0_VL&._ Distance from foundation__. d-__-------- Distance to nearest lot line.______ [� Number of lines________ _ ___ Length of each line ----- _.______._.Width of french____ A5,1....... -------------- Type of filter material --------- Depth of filter material ----- /R�'.___._Total length ---- Z3`-------------------------- -� �.. Seepag it: Distance to nearest j`ell____----- Distance from foundation --- a_Q__._.____.Distance to nearest lot line___.___________ Number of pits -------- Lining material 5�.,84l__ -ize: Diameter __..-3 -------------- Depth--------- _ _---__----_______ Cesspool: Distance from nearest well ----------------- Distance from foundation ___.__,______-____.Lining material .__-__._.._______________.----------- ' GI, ❑ Size: Diameter=------------------------------------DePth----------- ----- -Liquid Capacity --------------------------gals. ----------------------- ------ ---- Privy: Distance from nearest well ----- -- -------- -------------------------------- --Distance from nearest building____ __.__---._______________________-._. ❑ i pistance to nearest lot line. - ------'----=------------------,..r� ---------------------= ------------------------------------------ ----- 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.Stafe�laws, andrruln and regulations of the^ San Joaquin Local Health District. (Signed}!__._.~` ------------------------------`-f-- Contractor] By-------------- - - -�r� x -' ------------ --------(Title --- _ - --- ------ --- ------------ (Plot pian, showing size'of lot, location of -system in relaflon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -------------------- -------------------------------- DATE---------------- . — . - -- ------------------- REVIEWEQ BY DATE------------------- --------------------------------------- ---------------- BUILDING PERMIT ISSUED----------------------------------- 7- ------- m -------•--------------------------------------- DATE ----•------•----- Alterations and/or recommendations: -------------------------- -------------------..-----• -. ..... ..--------------------------------------- -----------------------------------------------------------------------------------=------------------------------------------------------------------------------•---•-------•----------------------•--------------------- -------------------------------------- ---------------- •-------•---•-•------------------------------------•----------•----------------------------------••-----------------------------------------------------------•--------[� ---------------------_-------- U, '��✓ FINAL INSPECTION BY: - -4 -------------------------------------------- Date------------ •---• ------------------------------------------- t 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 ; . Revised W-2100