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V/ 4 APPLICATION FOR SANITATION PERMIT Permit No. .___._� ..5- (Complete in Duplicate) Date Issued _4/$rb; 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 jL CATION---- i s '_ ---------------------- ------------- - -------------------------•------------ Owner's - - Phone Address . .) -----•-------------•--------------------------------------------------------------- -------- Contractor's Name- -------------------------------- Phone. �2 f 1° -- - ------------------- Installation will serve: Residence par meat House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ x � _ Number of baths .-1__._ Lot size ____ ®.__ _ ....Number of living units: _ ] Number of bedrooms �-�- - X------�- � �E t"--- I Water Supply: Public system ❑' Community ,system ❑ Private �-Bth to Water Table _' -- ft. : { Character of soil to a depth of 3 feet: Sand F1 Gravel FI Sandy Loam El Clay Loam El Clay E] Adobe ardpan ❑ Previous Application Made: Yes ❑ No RI'lNew Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ink• pistance from nearest well,a_______________Distance from foundation___-_______-._.____.Material________--___-__.______._________-____-___._. No. of compartments--------- ---------------Size------•---=---------------------Liquid depth---- Capacity f2.'_--.Distance to nearest lot ;sposal Field: Distance from nearest well--'.0..'___Distance from foundatio __ umber of lines.--___ ---Length th of each line------- l�-_�___---___.Width of trench_....�;q__...__-___..._____.- �_ �r r. f Type of filter material___ --------------Depth of filter material____ -- ____Total length___. D.__.__________.________..._ .- Seepage Pit: Distance to nearest well._. l_D--`_-_Distance m fo dation____��- _._.Distance to nearest lot line_0— i �3 -rr Depth -A-rJ--r---------------- Number-of pits.-_._-�- -----------Lining material-- --•- ------ ----Size: Diameter_-- _ w " -' Cesspool: Distance from nearest well_______________ Distance from foundation____.______._._-- Lining material__-_____.__.____.._--_-_.._____-_____ Size: Diameter----- ------------ -- ------------- -Depth-- ---------------- ❑ --------------------- -----Liquid Capacity------- ------gals. Privy': Distance from nearest well---.---------------------------------------------Distance from nearest building-----..________________._--------------. Distance to nearest lot lire-------------------- --------------------------------------------------------------- Remodeling and/or repairing (describe):------------------- ----------- ----------------------------------•------------•------..--------------------•----------------------------------- ---------------------- ------------------------------- --------------------------------------------------------------------------------------------------------I----- ---- - ------------------------------------------------------ •-----------------------------------------------------------:---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances; State 11,9ws, an ules a d regula+ions of the San Joaquin Local Health District. i (Signed)..- -------------- {Qir+—aSILl�ontractor) .g a. Y --------- ----------------------------------------- (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,,._.._. ------ � REVIEWEDBY----- -- ----- -----�� ------------;--------- ---------------------------------- ----- DATE BUILDING PERMIT ISSUED-------------------- - - - -------- --------------------- DATE.. �3' Alterations and/or recommendations:------------------------------ --•-------------------------••---------•--•--------•-------------------------- ------•-•----------- ------- -- --------------------------------- ------------------ -------- { ------------- - --- ----- -------- ---- --------------------- -- -------•------------------------------ ---------•-- ----------------- •---•- -•----------------------------------------- ---------- FINALINSPECTION BY:.........................�-------------- -------------- Date... ................ ------- -----------------•--------------------------- 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 a ES-9--2M 145445 nrw000 12-59