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P T APPLICATION FOR SANITATION PERMIT Permit Nv __�~.�__• ___ (Complete in Duplicate) JJS'v Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Tiapplication is made in compliance with County Ordinance No. 549.;`t . . . JOB .ADDRESSAND°LCGC TION Sj-1 °' Ss ri�uv c_u--2 -rr / c'1 --- �=`� ------ Owner's Name-----•-----------H--�=-r p f►�yg 11C�� - P ne-------- ----------- w ------------------ ---------------- ----- 5' Q � -------` �4_n_ i_.. a f! n Contractor's Name---------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- lns+allafion will serve: Residence '® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J____ Number of bedrooms +3-___ Number of baths I_____ Lot size ----Flo_---Y-_ 4-6-------------------- Water Supply: Public system ❑ Community system ❑ Private 5§ Depth to Water Table __S_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑, Sandy Loam ❑ ,.Clay Loam ❑- _Cla_y_O-._Adobe:0 -Hardpan Previous vApplication Made: Yes ❑ No K New Construction: YesNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----6A_____Distance fiom foundation------1_Q--------Material__ _0 _� t`r______________ No. of compartments_______._�-.______-__Size_�A_gX__ ___________Liquid depth-------y_______ Capacity_____ Pn___gd Disposal Field: Distance from nearest well---------------Distance from foundation__-_______________.Distance to nearest lot line___________f______ ❑ Number of lines------------------------------ ---Length of each line------------------------------Width of trench------------------------------ - Type of filter material____-------------------Depth of filter material-----------------------Total length___________----.____________________----__ 0 i r• Seepage Pit: Distance to nearest well-------&V--------Distance frsor�n fo ndation__-:__1_--------..Distance to nearest lot line___ ,i p !_ � Number of pits-------)-------------Lining material�._._._i"r�ic� Diameter----fib__-------___.De th____1_��--------�____-_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___:_________-_____________________.�1 ❑ Size: Diameter------•-------------------------------Depth---------------------------------------------------Liquid Capacity �:_ ----------gals. Privy: Distance from nearest well______________ _ ____________ .. ---Distance from nearest building-----------------------------------._____- ❑ Distance to nearest lot line---------------------------------- ----------------------------------------------------------------------- % K Remodeling and/or repairing (describe):---------------------------------------------------------------- -----------------------------------------------------• -----------.--------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-•-------------._.. i' _______________________________________________________________________________________________________________._»._-__________________________-__-_____________-____________----_____.---------------------------------------- I ___---.__-________________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, apd rules and regulati s of the San Joaquin Local Health District. r (signed) - dam' °`x -- - ------------------------------------------------- -----( wnerand/or and/or or, Title Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------------------.--"- QDATE----------- REVIEWED IL BY--------------------------------------------- -------------------------------------------------------------------------------- DATE---------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------- ------------------ -------------------------- Alterationsand/or recommendations:----------------------------------------------------------------------------------------------------------------------•---------------------------------------- -----•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ ---------------------------rd--------------------------------------- ----------------------------.----------------------------------------=---1------------------------------------ Dae- 2 ----------------------------------FINAL 1N5PECTON BY: f ' 4 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 B-51 Revised W-2100 i