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K APPLICATION FOR SANITATION PERMIT 4 Permit r�i (Complete in Duplicate) Date Issued 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 LOCATIO �-_-6 ----------k-- -- T--------V c-----l- ' -- -------- ---- IJ �- x.1 _ Owner's Name------------------� - �' } 1Q Phone.-. Address , ._-----------------•--------------------------- -- Contractor's Name. ---------- --------------------------------------- -------------------------------------------- Phone...-------•------------- Installation will serve: Residence D�_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other--❑ '._Number of living units: -------- Number of bedrooms __- Number of baths --1--_ Lot size ---_�-`-: -/74� ------------------------------- Water Supply: Public system [X,, Community system E] ❑Private- Depth to Water Table ----_--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ CIO—y-[:] Adobe 44 Hardpan ❑ Previous_Application Made: Yes ❑ No [0 New Construction: Yes ❑. No,K { _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wifhin 200 feet.) Septic T : e Dist`arice' from nearest'well-____.----_----_Distance from foundatio`-11xp--_______-Material---------------------------------------------._-. of compartments --------Size-------•---•-------------- -----L+quid depth- --------- --------------Capacity--•------------- - Disposal Field: Distance from'ro-earesf well------------------Distance from foundatioh-----!-0__--------Distance to nearest lot line------5---_�—, Numbers of lines------- -----------: { _____. Length of each line__-____ �� ::��______.Width of trench------ ---_2(Vef I Type or filter materia�L_ ___-____Depth of filter material•_-a__��-g_--------.Total length_`--------_- ----- 1 v Seepage Pit: Distance to nearest well-._--------------------Distance from foundation-----_ :----.------Distance to nearest sof line-_---.._-- ❑ Number of pits -..----_----------Lining material----------------------- Diameter------------------------Depth------------------------------ Cesspool: ---------------------------Cesspool• Distance from nearest well-----------------Distance from foundation----�--._.-____--.Lining material-_-__---._--_----_.---__ ❑ I Size: Diameter----------'--------------------------Depth------------ -------------------E --------------Liquid Capacity----- --------------------gals. t Privy: Distance from nearest well--------------------------------------------------_Distance#from nearest building-------------.---___-_- El Distance fo nearest lot line-------_-------_____--.-.- ------------------------------------- Remodeling and/or repairing {describe]: _ n# F --••----------•----------------------•------------•-------•---------- --- ------------- -------------- ---------------------------------- o =- --- - - -- ------------- --- ----- ------ - - - --- I hereby certify that I have prepared this application and that the work will lie done in accordance with San Joaquin County ordinances, State laws, and tules andregulations)of the San Joaquin Local Health District. (Signed)----Al--717V&4--'14-�t�g------ � ----------------------------------------------(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 ---------=--- ------------ - ------�--------- ------------------------------------------------------------JV- -- --------- ------- ----- - ------- DATE------------- ,�-.--- --- BUILDING PERMIT ISSUED__'------------------------------------------------------------------------------•--------------------- DATE---------------- ----------- Alterations and/or recommendations:--------------------------------------------- ---= --- ----------------------------- -------•------------------------------------- ----------•-----------------------------------------------------------------•-------------------------------------...----------------- -•--- ------------------------------------------------------------------------------------------- --- J� , FINAL INSPECTION BY----------------------V--____��_ ---- -------- Date-------------- - -- -- -----�_. ---------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M 10-52 Revised W-2100