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ff,/ APPLICATION 'FOR SANITATION PERMIT Per it No. ...._a__ _�___ N 7 (Complete in Duplicate) l®1 Date Issued 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 O rAante N,2,s 549. JOB ADDRESS AND LOCATI N-----------— ---- ------•-------------------•-------------------------------=---------------- Owner's Name----- � Phone -------------------------- Address ---------- ---------- Address >> # =------ - •------- .............. .-------•-------•----------------------------- --------- - Contractor's Name-. ---- Phone -- -----------------=----------- -- --------------- Insfalla+ion will serve: Residence ❑ Apartment House ❑ ommerc- ' Trailer Court ❑ Motel ❑ Other ❑ Number of living units:__ Number of bedrooms Number of baths�4'2__. Lot size _ «_ _ _-____--____________ i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table'd.C, ft. i. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobejk'Hardpan ❑ Previous Application Made: Yes ❑ No-SR" New Construction: Yes ❑ NeXT' 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------------------------------------------------- A~A�" ;iiVC% No. of compartments------ -------------------Size--------•-----------------------Liquid depth---------- --- --------Capacity----------------------- Disposal Field: Distance from-:nearest well____.-.--------Distance from foundation--------------------Distance to nearest lot line______._____-__-_ QS jyCP Number lines-----------------------------------Length of each line-----------------------------.Width of trench-------------------------------- Type of filter 'Material_--_------------ ___ Depth of filter material-------------- --------Total,length_____-________.______-_______________'___. 4 x Seepage Pit: Distance to nearest well Distance f m to dation___- ------------Distance to nearest lot line_. Number of pits---- /--_-________ fining material Size: Diameter_I . _a --------Depth___ �J'-`� ---------------- tACesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.___-________________.____--____.__ ❑ Sizc: Diameter--------------------------------------Depth-------------------------------------------------...Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest.building__._______.__.________________.._________- ❑ Distance to nearest lot kne---------------- --------------- ------------------------------- -------------------------------------------------------------------- 1 1 S 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, St aws, a rules and regulations of the San Joaquin Local Health District. ___________________Owner and/or Contractor (Signed).. ..� B --- - -.. �. ------- (Title y� --------------------------------------i i (Plot plan, showing size of to , location of system in relation to wells, buildings, etc., can be paced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------ -------------------------------------------•-----------------••---------------• DATE--- -•----- -- ------------------------------------ REVIEWEDBY------------------------------ - ----- --- --------------------------- ------ - - ---------------------------- DATE. �– ---------------------------------------------- p BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE.------•- `me---------- ------------------------------- AIr erngpd/oryrecomP mendaEons------- ------- ------------------------- ' -------•----....- ------- ---- _______________.___._------___._____-___._____________--_..________________-_._____________________.______.--.____..._-___-___-________.__-_______.__----_____-.-_--- _______---.-__.-___________ _____________---.._.--. _______________________________________________________________________________________________________________________________________________________________________________________________________________________ FINAL INSPECTION BY:.---- --� ----;----------------------------------- Date: LI f `�� -------- 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-2100