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.r PLICATION FOR SANITATION P ./lIT Permit No. (Complete in Duplicate) Date Issued ---_�1171.5__y 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. JOB ADDRESS AND LOCATION 3----------- ff 'E'----=------------- - �r _ #1 Owner's Name-•-•---------------------��.�-••--•1'+i-�-��----•-----�d�t�- -1�- ---�? �� -------- Phone------------------------------------ Address ---------------------------------------------------------------------------- ------------ -•-- Q Installation will serve: Residence ❑ Apartment House ❑ Commercial rJ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: ________ Number of bedrooms --------- Number-of baths ...... Lot size --------- &4___el______________ Water Supply: . Public system ❑ Community system 0 Private ❑ Depth to Water.Table -------- ft. Character of soil to a depth of 3 feet: Sand d Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe- Hardpan ❑ Previous Application Made: Yes ❑ No 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.-__.____---Distance from foundation------jQ___-------Material------------- __�fi_w- _:__-_._ No. of compartments------------.----------Size------ --Liquid depth---------yj_'r__------Capacity--• UJI .-- 7__-•-•- Disposal Field: Distance from nearest well .___!1______Distance from foundation.._._..24d: .._.Distance to nearest lot li ____-_-•_ Number of lines_________________ _I Length of each line---------140....__.........Width of trench----------.q___ Type of filter material-------�-l�,___-___---Depth of filter material------14'__-__-------Total length-------------1eQ.----------------_-- Seepage Pit: Distance "to'nearest...wL el _____________________Distance from foundation--------------------Distance to nearest lot line----------------- Number of plits---------------_------Lining material-----------------------Size: Diameter----------------------- ' Cesspool: Distance from nearest well________________Distance from foundation---------------------Lining material__.___-______-_-___________________-. - €,., ❑ Size: Diameter-------=-----------------------•---:_Depth-------•----=-----------------------------------•---Liquid Capacity--------------------------•-gals. ! � y: m nearest well______:-___________________________________._Distance from nearest building - G ------ Privy: acro g-----•-------- ------------------------- - Dista nce`�to�nei3rest-lot line---==-----------------------------------------------------••--------------------------------- Remodelin or epalr ribej:. _`._ - `--�-------�o----- l') a. �r_ _+ ------- r -77 --- - 1A p R i ---------------------- -----------------------------•---------•---- ------------------•-•-......-.....................----••-•---._. --------------------------------------------------------------------------- i I hereby certify that I have prepaeed this application and that the work will be done in accordance with San Joaquin County ordinances, Stye laws, and rules and regu tions of the San Joaquin Local Health District. J (Signed)---..�•._..... = (Owner and/or Contractor) i By:••--••-•••----•--•-••••••-•....--••••• --------------------------------------------------------------------------------------{rifle)-------------------------- ----- I (Plot pian, 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_......... �� DATE------------ -- ------- ------- BUILDING PERMIT ISSUED----------------------------------------------------- •-------- DATE-----------------------------------------•------------------ Alterations and/or recommendations,-_________ __� _.... ...... ---------•---------------------------------------..........------.....-�------ ---- "-------------- -: --------•-----...---- ,: --------- ------ _ - ...... ............ ----------------------- --------=-----------------------•---------------------•---------------------------------------------•---------------------- ------ -- ---------------------------------------------- - ------------- FINAL •-------FINAL INSPECTION BY------------------ ------------------------------------ Date----------- = SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M ; " Revised ^0 i