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APPLICATION FOR SANITATION PERMIT Permit No. J1_-17-1-3 i (Complete in Duplicate) Date Issued /0 - -5-- 5- Date 3� 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. ( � `'�•'s JOS ADDRESS AND LOCATION s `7r/ f 2��---/-.1�- ------------------------------------------11------------------- Owner's Name ' s F - - -- "" Phone Address 'ld --'----^------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name-----------------------------------------14 ----------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other A Number of living units: ----L Number of bedrooms __/--- Number of baths -----.__ Lot size ------7 -X !7S_-_ _- Water Supply: Public system K 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 J ' Hardpan ❑ Previous Application Made: Yes 01 No ❑ Now Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200+_ feet.) // Septi Tank: Distance from nearest well----&^4� Disfance from foundation /-�_t_------Material___------------�� No. of compartments---------�_-----------Size-----3: - _7_____Liquid depth---------- -`4__°_ p y______ -_Ca acit 15-rQ Disposal Field: Distance from nearest well-__i1+_ti-•C-Distance from foundation------ ©-------Distance to nearest lot line---�_----- Number of lines-----------I- - ------------ Length of each line---------- Width of trench--_-----__"7'� �j„------____ Type of filter material________________ Depth of filter material-----__-� -------- otal length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation_-_-_---_--__-_----.Distance to nearest lot line----------------- C> ❑ Number of pits------- ------------Lining material-----------------------Size: Diameter-----------------------.Depth_-=-____-------__-_------_------ 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):---------` / -------- ---------------------- „---- ----------------------------------•----_-------------------- --------� ! �f(1 .-' '� n + ------- -------- - - ----------- - -- - ----•--- ._ _ ----------- 1} " {- P0 r - �, - - ---- - I hereby certify that I have prepared this application and that the,+ oA will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)K = -------------- ----------- ==- --------------------------------------------------------------------------------- ---------(Owner and/or Contractor) y�Bn d -------------------------------------------------- ----------------------------------------- Y•= 1 (Title) ---------------------- (Plot plan, Sir size of lot, location of systemelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- -- ------------------------------------------------ ------ DATE------------- r ?r'� REVIEWED BY - --------------------------------------------------------------------- DATE--------------------- REVIEWED PERMITISSUED-------------------------------------------------------=--------------------------------------------- DATE = Alterations end/or recommendations:--------------------- ------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------- -------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- a r FINAL INSPECTION BY-------------- - Date---- -- -_-j- 1/j - _-- _ --- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ 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