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APPLICATION FOR SANITATION PERMIT Permit No. _C -_��-- [Complete in Duplicate] Date Issued _----/1:2-7- _5- '- Application is hereby made to the San Joaquin Local Heaifh District for a permit to construct and install the work herein described. This application i in mplian ith Cou y Ordinanc No. 549. gy'^ JOB ADDRESS AND LOCATION_- ------'---2--- / d , c.. Phone-_4 4K Owner's Name-------------------------------------- - - - - - - -----------------•-------._ - ------------------------- • -----------•-------- �-� - Phone--- ----•----- --- Contractor's Name------------------------ ❑ Installation will serve: Residence Pq Apartment House El Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---_ Number of bedrooms __IL77- Number of baths ---/--- Lot size -------/---_- C140- ---------------------- Wafer 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,pt Hardpan ❑ Previous Application Made: Yes El No New Construction: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.I 40 Septic Tank: Distance from nearest w T/__ Distance from fou ndat on-_�-------------.Materiah No. of compartments -- Size_ _-____ sP-- '°'�-V Liquid depth-- --=-----------Capacity-.. _ - - '--__Distance to nearest lot line.--/f_''_ " Disposal Field: Distance from nearest well..��_'�__-Distance from foundation___ - �� Number of Isnes____I------___-- �r _ ----Length of each line---/�_2_0�er--`_-_---------Width of trench___,-_2 /------------ ----- 4 Type of filter material----- _i = _ __Depth of filter material-_- O f_..........Total length_._�'. G*____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---_------_-____ i ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth------------------------------- Cesspool: Distance from nearest wellR______________Distance from foundation--------------------Lining material- ------------------------------- Size: Diameter --------- --Depth_----- -Liquid Capacity----------------------------gal s ❑ _ ' Privy: Distance from nearest well--------------------------------_.--__-----_---Distance from Weare fs bui ding: !"- , ❑ -------------------------- Distance to nearest lot line------ --------------- --------- ----------------••---- ------------------------------- �----- ------------- r -------------------------------------------------------------------------------- Remodeling and/or repairing (describe)-----------------------------------------------•-----•------------------ --- --------•------------------------------------------------------•-•---------------------------------------•---•- --------------------------------------I—--•-- ------------------------------------------------••------------------------------------------------------------------_--------------------------------------------- I ---------------- :r------ I hereby certify that I have prepared this appl' ation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ruI s and regulations f the San Joaquin Local Health District. 4� ----------------------- ------- + " Contractor] [Signed----- - - - ----- r ------------------------------------ ----- ---------------[Tiff ^ a-tis (Plot plan, showin size of lot, Iocatio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --------------- ----------------------------------------------- ------------ DATE% REVIEWED BY_ DATE - - -----------------------•--------------•--- DATE--------------- -------------------------------------------- BUILDING PERMIT ISSUED------------ -------------------------------------------------- Alterations and/or recommendations---------------------- -- ----------------------•----------------------------------- --------•----. ----- '�L -------------------------------------- FINAL INSPECTION BY------------- ---- Date--------- - d { ---------------------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Tracy, CaliforniaStockton, California Lodi, California Manteca, California ES-9-2M 5-51 Revised W-2100