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777 -�' APPLICATION FOR SANITATION PERMIT Permit No. __aze-ZS (Complete in Duplicate). �i Date Issued ----/ :-a "S k Application 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- -.5__ '� Owner's Name--------- W. � � �� ' h ----- - •-- -----•---------------- ------------------------------------- Phone ----------=----------- --------------- Address----- ------ RU n ------------------------•-•-------------------------------------- -----------------------------•---- Contractor's Name----------- -- = j..-_ '� � = ! f----- Phone z.-_7_IA f Installation will. serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court � Motel Other Ll �-'•ice,-f Number of living units: _, - Number of bedrooms �__ Number of baths ---3-- Lot size . _ /x__ tJ _____________________________ k Water Supply: Public system Comm unity'system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe U5 Hardpan E3Previous Application Made: Yes E] No El 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_______--_____-__ _. _ Material------ ------------- -------------------------� ❑ No. of compartments------------------- -------Size--------------------------------Liquid depth--------------------------Capacity-- Disposal Field: Distance from nearest well------------------ from foundation--------------------Distance to nearest lot line______._____.____ ❑ Number of lines-----------------------------------Length of each line_-----------------------------Width of trench--------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------------------..------ See e Pit: Distance to nearest well_--_____________Distance from foundation_____- -- --- -_-Distance to nearest lot line�_.A-2--� t Number of pits--r_____ /-----------Lining material____ _ _4�C__$ize: Diameter__--?TA'-_......... Depth-----, _�}--------- — Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining ❑ Size: Diameter--------------------------------------Depth-------------_ --_ - Liquid Capacity _ _ - ,.,.�_. ..r;. �.-....s-:_ :t ._ . ...,..�..� ------------ ---------gals. Privy: Distance from nearest wellT___ — __ --Distance from nearest building"`---' """'� ' g; ❑ Distance to nearest lot line------------------------------------------ ------•_-----_- ; 1 � Remodeling and/or repairing (describe):___.------- � -- -- ---- - ------ --------------•---------------------------- -------•---------------------------------------------i--•--------- - -------------- ------------------------------------------- ------------------------ -----------------------------------------------•-------•------------------------------------------------=--------------------------------------=------------------------------------------------------------------------- 1 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, (Signed)-------------- -----•------�--�------- --------------------------------------------------------(Owner and/or Contractor) BY: ? (plot plan, showing size of lot, location of sy�s�tem in relation to wells, buildings, otc„ can be placed on reverse side). ,y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ± L�=-------------------- DATE _r__ K-- ---- REVIEWED BY ------------------------ DATE -------------------- ---------------- BUILDING PERMIT ISSUED ---------•------------ ---------- - ------ ---- -------------------- DATE---------------------------- --- ------------- ---------------------------- #erations and/or recommendations_______________________ ---- --------------------------------------------------------------------- - --------------------------------------------------------------- --------------------------------------`---- - -------------------------------------------------------- --------------------------- FINAL IN5PECTION IN5PECTION 8Y: bate- . ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+ockton, California a Lodi, California Manteca, California Tracy, California f ES-9--2M 8-51 Revised W-2100