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APPLICATION -FOR SANITATION PERMIT Permit No- _ r_ ------- (Complete in Duplicate) -? � _Date Issued/v_/�--:--•-_-- 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 AT 40 J - I i = � Owner's Name---- - --- - -- - --------- ---- ---- - - -------------------------------------------------------------------------- Phone_0____C_____,`1-- _ Address------- ---- �-'�-D---3------------- --- --- - --- -- -------------- --------_--------------------------------------- --------------------------------------------- Contractor's Name------ ------- ------- ------------------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve:. Residence)) Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other`❑ Number of living units: ____J_ Number of bedrooms --- Number of baths _1____ Lot size __-__ _(.l_.x--_0_0------------------------ Water Supply: Public system [Community system 0 Private E] Depth to Water Table -------- ft. F Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo;"PNo Clay Loam I] Clay El Adobe Hardpan E]Previous Application Made: Yes E] !No Z New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t.-.' Septic Tank: Distance from nearest well '""-----Distaance fro fou �tion____ ________.Ma --- No. of compartrnents----------Z-----------S-ize_�1__ _-�------Liquid depth--------P�-f'�F----------------Capacity----- � *---- Dispos Field: Distance from nearest well---ra-• Distance from foundation----_I_Q-------Distance to nearest lot li e �-_�________ I Number of lines__________ _ Length of each'line____--___________ _______Width of trench_________ _ Type of filter material_ _______ JDepth of,filter material_______ _-_-______Total length--------ik_o ____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------______---__ ❑ Number of pits----------------------Lining material--------------- -------Size: Diameter`--:---------------------Depth-_------------------------------- q Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- ❑ fSize: Diameter----------'=�----------- ------Depth------------------------------.=-------------------Liquid Capacity---------------------------gals. r Privy: Distance from nearest well_' ____________________________________-_____-Distance from nearest building------------------------------------------ Distance _________________________- ___________- Distanceto nearest lot'line--------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)=-----------------------------------------------------------------------------------------------------------•-----------------------••-------------------- I ------------------------------------------------------------I------------------------------ ------------------------------------------------------------------------------------ ----------------------------------------- ` --------------------—--------�--=----- -----------—---p------------------pp--------------------------------------------------------------------------------------------------------------- ty I I herebycern that I have prepared this application and that the work will be done in accordance with San Joaquin Coun d regulations of the San Joaquin Local Health District. ordinances, State laws, and'rules an I _-___Owner and/or Contractor (Signed -E� �'�---------- --- } �Y ---- -------- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. t I FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED B I DATE___ _ -- --------------------------------------------------------------------------------- ----------------------------------- "eREVIEWED BY - - = DATE - BUILDING PERMIT ISSUED DATE - - L------ ----------- ------- Alterationsand/or recommendatlons ------------------------------------------------------------------------------------------------------- ------------------------------------------•-•---------- -------------------------------------------------- - ---------------- ------- _ --------------------------- - --------------------------------------•--------- -------- -z- ---"------------------------------- - ---------------------------------------------------------- ----------- --------------------------------------- ---------------- ----------------------- Dafie____- ..^_r ` ------------------------------------ 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 Y ES-9-MM 8-51 Revised W-7100