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u , PPLICATION FOR SANITATION PERMIT Permit No A 5 , (Complete in Duplicate) Date Issued b _ . pplica{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 compliancew'th County Ordinance No. 549. JOB ADDRESS AND LOCATI/� ' / �' 5�� .__ rt`"f ` rPP -------- ► . -- �rf3 Owner's Name------C`-'--!--/__"----�--•�`'4�_l�S17L%�-�-.•-----------•--------- ------------------ -- ---------- Phon�-----------•-------------- Address-----•----- --- -------- ----------------•--------------------------------------------------------------------•----------- r "��'-� ------------ Phone--�a-------r---- -7---- Contractor s Name----------------------_----- � Installation will serve: Residence jg lApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._f--- Number of bedrooms . __^ Number of baths -----Y Lot size ----__ I--4fl-------------------- Water'Supply: Public system ❑ Community system ❑ Private V Depth to Water TableJO ft. Character of soil to a depth of 3 feet} Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ AdobelRf Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes 0 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-1-6-O."_-Distance from foundation---1.0_----------Matenal- _....._R____ Q.. ig No. of compartments.. P----------- - ----Size45P—' `¢--Liquid depth_ ___.._______'�'a —tyyo_po_�_U Disposal Field: Distance from nearest well__1_10 -.-Distance from foundation--I_p.........Distance to nearest lot line-_---- Number of lines-----/-------- Length of each line------ --�---- ----------Width of trench - _-- -----------------_----- r - �----- -' ; w Type oT filter material_/_�2_.ADepth of filter material-------- Seepage length_______ _ __ ____________________ --• 1� _ Distance to nearest lot line----- Nu --_ Seepage Pit: Distance to nearest well_I_Q�.-..______D•sstance from foundation__Z-'.__7 ____. �� I � � Number of pits.--I----------------Lining material Size: Diameter-- -------Depth---�- --_.-..------------- S Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-____-__---_---------.--_----___-. ❑ Size: Diameter--- ----------Depth----------------------------------------------------Liquid Capacity- --------------------------gals. , Privy: Distance from nearest weil------------------------------------ ------Distance from nearest building------------------------------------------ ElDistance to nearest lot line------------------------------------------- ------------------`------------------------------------------------------------------------------- Remodeling and/or repairing (describe) ---------------- ---------•-----------------------------------------•---------------------••----------------- -------------- ----- ---------------------------•------- i ` - ----- --- -- --- --------- -----------------•---------------- - ------ I herebPa E-efify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, rules and regulati ns of the San Joaquin Local Health District. Contractor(Signed)------- -------------------- ------- ------ - -- -1---- --------• ------------- -------------- ---- ` ) - ------------ (T�+I .0 _ _ y ' - (Piot pian, showing size of lot, location of system relation to wells, buil s, etc., can be placed on reverse side). r ' FOR DEPARTMENT SE ONLY APPLICATION ACCEPTED BY---------t---- ------------- DATE------- �` ------------------• REVIEWEDBY----------------------------------- ' - ---------------------------------- ----------------------- DATE BUILDINGPERMIT ISSUED----------------'-------------------------------------------------------------------------------------- DATE-----------------------------------------------------...... Alterations and/or recommendations---------------------- -------------•-------------- - ----- ----------------------------- -----------------------1------- ..__ __..------•---------------------------- ---------- ------------•--------------------------------------- --------------------•----------- -------•-------------•-- FINAL INSPECTION 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 ES-9-21v1 : Revised W-2100'