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1V APPLICATION FOR SANITATION PERMIT Permit No [}� 21, (Complete in Duplicate) 7` 6 vvv �1 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wothhein described. This application is made in compliance with County Ordinance No. 549, 94 V JOB ADDRESS AND LOCATION.----� Z 9-B--X ��`f 1 ----- Owner's Name -------------------------------- - ----------- ------------ ------------- Phone------------------------------------ Address --------- -------------5----------------------------•-----------------------------------------------------------------------------•---- Contractor's Name------------------ •----------•--------------•-------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___-/__ Number of bedrooms J---- Number of baths -_/____ Lot size _____��-�_�-_?2__OD_�----------------- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 21 Hardpan ❑ Previous Application Made: Yes ❑ 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: �1• Distance from nearest well_________________Distance from foundation_________-________-Material __-______________-______________________-______. El {X t5 No. of compartments--------------------------Size-------------------------------_Li Liquid dep th---------:---------- Capacity F-�` 9 p tY Disposal Field: Distance from nearest well--_-_ �______Distance from foundation....C.��--------Distance to nearest lot line__-/�---_____ Number of lines_-----____f}'H_2Length of each line--------- `--_____-Width of trench...... _ -�'------_______---- Type of filter material-__-�4 -------Depth of filter material------/-______.__Total length________�_5_ ___________ _ ____ Seepage Pit: Distance to nearest well----------------------Distance from foundation_____---------------Distance to nearest lot line----------------- F-I Number of pits----------------------Lining material-------------_---------Size: Diameter------------------------Depth---------_----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------- ------------Lining material-------------------------------------- 11 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------------- M Distance to nearest lot line----------- + Remodeling and/or repairing (describe):--------------------------------------------------•-------------------------------- •-------------------------------------------------....... ---------------------------------------------- ------------------------------------•--------------------•-----•---------------------------------------------------------•------------------------------------•--------------------••--------•-------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Z (Signed) t' =' -----------------------------------------------------------------------------------------------------(Owner and/or Contractor) B Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR RT NT US ONLY APPLICATION ACCEPTED BY t r "�i - – ------ DATE--------2 ---�-..--- ----- REVIEWED BY DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterationsand/or recommendations---------- ---------------------------- ----------------------------•--------------•------------------------•-------------------•----------•-------------------- ---------------------------------------------------------------------- -----------------------------------------------------------------------------•------------------------------------------------------------------------ ----------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------•------------•-- ------------- --------------------------------------------- -------------•----------------------------------------------------------------------------------------------- FINAL INSPECTION BY-- --- - ---- ------�------- ------------ Date--------7- ...:4-3- �----------------------------------- 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-9-2M 8-51 Revised W-2100