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Vy APPLICATION EOR SANITATION PERMIT Permit No. . -7_.:5.x__..(Complete in Duplicate) Date Issued --_. --3-vs�Applicatiode t' 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----- � ' �-------------- Owner's Name _II' -------- -- •--------- -------•---- ----------------- ------ ---- Phone-S .--3 Address -- - -- ----- ------------ --------------------------•------•--- ---------- ----- ----- I� �^� -------'--------------------- Phone--- ----- i Contractor's Name-----�..-�..�.•egnr�.. ��"�. � ____-_ -_ Installation will serve: Residence 9�-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units::1 l____ Number of bedrooms __. -Number of baths .--/--- Lot size __� f__ ---1.. .a �---------------------- 5 � Water Supply: Public system', 94ommunity system ❑ ' Private ❑ Depth to Wafer Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ' Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [*"Pardpan ❑11, � Previous Application Made: Yes E] 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 wells.---Distance from foundation---IS-10----Material-- - ------------------------------- ------- �..�.- No. of co.r1lnpartments_____.__.___ '_..._-_Size__._.__ _ __5_ 3__Liquid depth_______ `?'``________Capacity------_S'� _. Disposal Field: Distance-from nearest well- _Distance from foundation-----ZS___....Distance to nearest lot line____/__d_..... [�- Type lines----------t--- Length of each line------ -D. --------------Width of french....2;Y__ -"------------------ Vii.A: 10 Type of filter material-�_.e_____��_-Depth of filter material-----�2-__-____._Total length-------?.41__________________________ 1 e Seepage Pit: Distance to nearest welLs�. F___Distance from foundation---- ___.Distance to nearest lot line--f ____ , Number o pits--------- ----- --Lining material Size: Diameter----3_4-- ------ Dept h_.__..?_s�__-'_---------------- Cesspool: Distance from nearest well-_______________Distance from foundation._.._.__._-_______.Lining material--------------------.------.__._____. l ❑ Size: Dia eter------ -------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------9 Privy- Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------- - ❑ Distance to nearest lot line------------------------------------ -----------------------------•-•-- •------------------------------------------------------------------- - Remodeling and/or repairing (describe) ----------------------------------------------------------------------------------------------------------------------------- ------ ----------------••-------- '------------------------•----------•-----•-••-----•---•---•-------------••-- ----------•------------------------------------------------------------------------------- ------------------------------------------------- 11--------------------------------------------------------------------------------- -- i ----------------------------- --- -.,1 - -----------------------------•--------------------------------------------------------------------------------------- ------------------- k I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. # -I�I - �----- �� ----------------------------- - ® Contractor (Signed)----- {. ) B ' - - ------ - Title -------------------- Y• - .--- �_ t -- ( ) (Plot plan, showing size of lot,!�location of system in relation to wells, buildings, etc., can be placed on reverse side). ' �I FOR DEPARTMENT USE ONLY ,1 I APPLICATION ACCEPTED BY-------------------------------------------------- -- DATE---------� - - -------------------------------- REVIEWEDBY ---------------------------------------------------- ----------------------------------------------- DATE------ ----- BUILDING PERMIT ISSUED.-All--•-------------------------------•-----•------------------------------------------------------._ DATE.---------- ----------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- ------------------------ -------------------------------------------------------------------------------------------------------------------------- ------------------- ---------------------'---•-•-- `��--------------------------------------------------------------------------------------------------------------------------------------------- IM' ----------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:---'-:-------1!__:.:.----- -------- 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-4-2M 10.52 Revised W-21001