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Permit No. ...-_2a-----! APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued --__��.______ ` -Application,is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. - -- nan�c e No. 549. This application is made in compliance with ACount Ord* TIOA_� F = = �\----\Y 11 ___W JOB ADDRESS AND LOCAr P .- Y�: Owner's-Name........... -- ----------------- one----------------------- Address-- ----------Address. P --- - --------- ---------------- .- Phone Vje: Contractor's Name------- . -� -- jF Installation will serve: Residence Apartment House ommercial ❑ Traile Court ❑ Motel �,/ er ,,V r Number of living units: __ ____ Nu er of bedroo --------------------- ms ___ --- Number of baths Lot size _____ - -1'----� Water Supply: Public system Community system fl Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ ravel ❑ Sandy Loam ❑ y Loam❑ Clay ❑ Adobe ardpan ❑ I Previous Application Made: Yes ❑ No New Construction: Yes o ❑ . TYPE OF INSTALLATION AND SPECIFICATIONS: L (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F" Septic Tank, , Distance from nearest well-----------------Distance from foundation ____________________Material____.__________-------------••••---------------•- ❑rr✓ No. of compartments---- - -----------------Size------- ------------------Liquid depth------------------------ Capacity Disposal Field: Distance from nearest well-______.___----Distance from foundation____________ _______Distance to nearest lo+ line____.____________ ❑� Number of lines-----------------------------------Length of each line-----------------------------Width of trench_-_------_---------------------•--- ' Type of filter material----------------------- epth of filter material-----------------------Total length------------------------------------------ _._____.Distance to nearest lot line_ Seepage Pit: Distance to nearest well/4 - 1� __ _--Distant m f and on_______ Linin material_ _ _._ ize: Diameter------------------------Depth------rg' 1 ------ ' ' Number of pi+s--- - g' Cesspool: Distance from nearest well________---_____Distance from foundation------____________.Lining materiaL_________-.___-_______.____________. V -----------_Li Liquid Capacity -------gals. ❑ � Depth---------------------- ----------- -- q p tY•------,-,--- -•-_--- , Size: Diameter------------------------- ---- - Distance from nearest well ____ _______Distance from nearest buil Ing______________ ❑ Distance to nearest lot line----------------,----- --- ------•-•- ------------------------ ----------------------- - ---------------------- ` 6 __________ ____7_ 1 _•_..._____----_____.____---- I 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 County ordinances, State laws,end rules an regui fii ns of the San Joaquin Local HealthP District. �„ -- ----- aer and/ r Contractor) -- --- (Signed) ,,- + ----- - ------------- ------------ - -------------:-----------------------(Ti ie)---- -- --- ------ -- (Plot'plan, showing-size of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------------------------------------------------------ DATE REVIEWEDB)'---------------------------------------- --- ------------------------------------ ----------------------- ---- DATE -- - � ----------- -- DATE-------------- ------------------------------------- ----- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------- Alterations and/or recommendations---------------------------------------------------------------------------------------- ----------------------------------------------- -------------------------------------------------------------------------------- ----------------------------------------------------------------------------------- ------------------------------------------------------------- I - ----------------------------- --------------------------------- J - FINAL INSPECTION BY------------ --- --------------------- Date.... F M SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Y Stockton, California Lodi, California Manteca, California Tracy, California P E5_9-2M B-51 Revised W-2100