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APPLICATION FOR SANITATION PERMIT Permit No. f (Complete in Duplicate) e Issued r a 3� Application is hereby made to the San Joaquin Local Health Distri t for a p rmit to construct and instalk.the work her sn described. This application is made in compliance with County Or inance N . 549, n i jam/ �JOB ADDRESS AND O ATIO ________ Owner's Name- ------- ----------- ----------------------- .------------------- ------------------------ Phone---- _-'^ �,—,- � Address- ---------------F----• - -----------------------.....-------------------------------------------------------.-....-----•---------------------------••---- Contractor's -Name---------- ----- --------------------------------------------------------------- Installation ---- -----.Installation will serve: Residence ❑ Apart House ❑ Commercial ❑' Trailer Court ❑ Motel ❑ that ❑�` Number of living units: -e--- Number of bedrooms -0- Number of baths _ Lot size _-__ __!___. r_ ______________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water TableoZilft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy .Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes E] NoNew Construction: Yes ElNXTYPE OF INSTALLATION AND SPECIFIC IONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 'h Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material_______________.___.____._.________-._-_._._-___. ❑ No. of compartments--------------------------Size---------------------------------Liquid depth------------------------:-Capacity------------------ Disposal Field: Distance from nearest well-------- --------Distance from foundation--------------------Distance to nearest loft line___________-_ ❑ Number of lines-----------------------------------Length of each line----------.-------------------Width of french-.-.----------------------__-_ Type of filter material____________________x___Depth of filter material________._.__.________Total length__ -.______________.__________________.__. (� Seepage Pit: Distance to nearestrrwell_____ _._-___Distance m fol dation___ vl___.Distan�e to nearest lot line_ ..__ Number of pits------[--------------Lining materia Size: Diameter--.-- -Depth_ _ ; - Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material---------------------------------- _. El Size: Diameter :---,--_Depth Liquid Capacity afs Privy: Distance from nearest well-------------------------_-----------------------Distance from nearest building__ -----.________._____-_-------__ ❑ Distance to nearest lot line- -----------------------------•------------------------------------------------------------------------ Remodeling and/or repairing (describe)--------------- _��------------------•--•--------------------------------•---------'=-----------------------------------------� ------------------------------- •------------------- - ---------•------•-------------------------------------------- \,!. --------------------------------------------•------------------------------------------ ----------------------•-------------------- -•-------------------------------- ----------------------------------•------------------- I hereby certify that I have repared this a plication and that the work will be done in accordance with San Joaquin County?v ordinances, Stat s, an u and regulati ns f the San Joaquin Local Health District. [Signed) - -- '"-�N---------------------------------------------------------------- --- --{Owner and or Contractor) T1tle By:. x [ ' ) ------------ (Plot plan, showing size of location of system in relation to wells, buildings, etc., can beep ed on reverse si FOR DEPARTMENT USE ONLY - APPLICATIONACCEPTED BY------- - -- - - ----- - -------------------------------------------------------- DATE--- ---------------------------------- REVIEWEDBY---------------------------------------------- -------------------------------- -----•---------------------------------------- DATE-----------------------------------------------•--------- . BUILDING PERMIT ISSUED-- -------------------K-- ' `` -- , ----------------r'ei- DATE----- ----- --;---------"--�`-�----�- --------------- �- -- i! �--------Alterations an or reeommendatione:---- -------� ------------ - •- -•-••-•-- ---- � -----------------------•------------------------------------------------------------------------------------------------------------------------------ --------------------------------•-- ----------------- - ---------------------------------- --------------- ---------- - ------------------------------ -------------------------------------- - ------------------------------- ---------------------•--------------------- ----•-= ---- -------•----------------------------------- --- --------------------------•--- ------------------------------------------------------------- ------- FINAL INSPECTION ----- ------------- Date._-- -- -_Y -- �r SAN JOAQUIN LOCAL ,EALTH DI T 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California f ES-9-2M 10-52 Revised W-2160