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ERMIT Permit No. 44------------ �/APPLICATION FOR SANITATION P (Complete in Duplicate) Date Issued A�catApplication ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplication is made in compliance with County Ordinance No. 549. � V.__ .__ ------------------------------------------- A JOB ADDRESS AND LOCATION.__-____: :--- -��I ----------- ------- Phone s2± Owner's Name------------------------ -I7RRE 4'23 - �. fx - ------------------------------------------------------ ------------------ Address--------------------------------------- ` . ------ Phone..... 1`6 Contractor's Name--------------- --------------------------- ----------------- /7 Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -)----- Number of bedrooms ---_ -Number of baths --.-/- Lot size -------7 _�___?�.----_ _Q�__'.__-__-..-- Water Supply: Public system Ig- Community system ❑ Private ❑ Depth to Water Table`_�- _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobejo Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e tic T Distance from nearest well-----------------Distance from foundation------------------- _..._____1W p __Liquid depth------------- -.-_Capacity ' No. of compartments - -----------� ------Size-------•---- -- ----- - -._ n -- ---- --- -----------------_ A isposal Field: Distance from nearest well- 'k istance from foundation_1-4-----.____-.Distance to nearest lot line___�1__.___,�_ g Q.r---------Width of trench__-V0--------------------Q Number of lines__________r____�_i_ __________Len Length of each line_____ p Type of filter material-_�_ ___f2_I----__-Depth of filter materlal.___.�ft--_. -----Total length--�iQ---------------------------- Seepage Pit: Distance to nearest well,io_ttF -____Distance from foundation!!!-9�____._..Distance to nearest lot line----- -----__--- M - .-- -r------------------ Number of pits---- ____________Lining materlal� ---Size: Diameter_�-c'x------ --- Depth____!i,5 Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-----------------------------_.___._. ❑ Size: Diameter--------------------------- ----------Depth----------------- --- -----------------------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line---------------------------- ------------------------- ----------- ------------- - Remodeling and/or repairing (describe):------------------------------ ------------------------------------------------- ------------ --------- ----------- ---------------•----------------•-------------------------------•------------------------------------•------- -----------------------•--------------------- ---------------- --------- I hereby tify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S ate laws, I d roll and regulations of the San Joaquin Local Health District. Contractor) -------------------- (Signed)----- ----- - ------ - fE� By:-----------------------•------------- -- -- ----- --- - Laf�iion L�"------ ------------------------(Title) ��- _L [Plot plan, showing size of lot, location of system ells, b lldings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--_-� DATE9 ----- --•------ -------------------------------------- --------------------------------------------------------------------------------- REVIEWED BY------------------------- DATE---_t----- PERMITISSUED-----•--- --------------•-------------------------------------•--------------------------------------- DATE----------( ---------------------------------------------- Alteratio and/or recommen ations:__------ --------------- --- ---------------------------------- '-----------------------•----------------------------------------------------------------------------------- --- ------ --- - ---------------------------------------------------- Date------ FINAL INSPECTION BY:_.___.----- ----------- - - 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 10-52 Revised W-2100 __ -