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�A 16 APPLICATION FOR SANITATION f J K� dg TION PERMIT Permit No. ---,5.-..____._._�_ (Complete in Duplicate) Date Issued ___ _�_/c__$'L Application is herebymade to the e San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance wit Coun Ordinance No. 549. JOB ADDRESS AND LOCA j0 ----- �-------KA—Z -�-1---------- _tv�4--------•-------- Owner's Name ----- 1----•--- ----------.- Phone_ ..- xl- Address---------------------= Contractor's Name e' I ----------- i-----------= ------ ------------------ ----- - Phone-.- I Installation will serve: Residence [ Apartment House ❑//��Commercial E] Trailer Court ❑ Motel [IOther ElNumber of living units: _. Number of bedrooms _1--Number of baths -_----- Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam D Clay ❑ .Adobe Hardpan ❑ I Previous Application Made: Yes ❑ No C( New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--8-1;------Distance from foundation---__-_ l Q , Material.-- - -- No. of compartments--- --------------------Sizer-Y36i--Z*-D Liquid depth.__ ��_-----_-----Capacity_ --- -- i ' Disposal Field: Distance from nearest well._:��^-___:_.Distance from foundation__.__ - �f�_.__;------Distance to nearest lot line------ A __�.�'.... �, Number of lines_1- E�- -----_/--Length of each line---;Z-5-' " g Width of trench ---------•-------------- ' 1 Type of filter material�1_�J__ �, De th of filter material---- ._. _11-----__ Total length---- I Seelpage Pit: Distance nearest ' rhst line-IV -------- - "lDace. fdDistance p'}s. Y -- material-,,- -Size: ter-_ Dept Cesspool: Distance from nearest well__-_--------.__--Distance from foundation--------------------Lining material-----.__. ---------- ------------------ ❑ Size: Diame#er----------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------- ----------gals. Ca Privy: Distance from nearest well-------------------------------------------------Distance from nearest building + El Distance to nearest lot line Remodeling and/or repairing (describe):.-_- + ------------------7-- ---=------------- ---...-- ------------ - �. -------------------•-----------------------------------------------------=-----------•-------- ------- ------•------- ------------- ------•---- ------------- --------------�-------- -----------h----------------------------------------•------ ------------------------------------------•------- ------------------------------------------------------- --------------- I hereby certify that I hjpr�epta�rethis application and that the work will be done in accordance wiSan ` aquin County ordinances, Sta laws, an l4' ons of th San Joa uin Local Health District. Si ned .( 9 ) - - ---------- --------- ----- - -- ------------- �� ---{Owner a /or ContracforBY - -------:- - ----- - -- V-------: j (Title) - (Plot plan, showing size of lot, location of system in elation fo wells, buildings, efc., can be platd on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- -------- f DATE ___.__ REVIEWED BY DATE ---- - - -- -------------- BUILDING PERMIT ISSi.IED-------------------------------------------------------------- ------------------------- ------ DATE- ------------------------- - --------------- - Aterafions and/or-recommendations:__r------------------------ ------------------------------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------- ----------------------------------------------------------------- a ------------------------------------------ -- ----- - ------------------------------------ -- --------------------------------- d - ------------------- r / FINAL INSPECTION BY__________ '-- --------- ------•--- -- ------- Date------------- --- I SAN JOAQUIN LOCAL HEALTH DISTRICT # i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street y Stockton, California Lodi, California Manteca, California Tracy, California I ES-9-2M 8-51 Revised W-2100