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0, APPLICATION FOR SANITATION PERMIT Permit No3f -----.. �Com lete in Duplicate) Vein p bate IssuApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install thework described. This application is made in compliance with County 0 rdinpince No. 549- . JOBADDRESS AND LOCATIO ------ o_C�---- -- - - -----------•-------------------•---------------------------------------------------------- Owner's Name --------— ----------- Phone. Address. 9 -- ---------- -- -----------------------p..-.. Contractor's Name.. ------- Phone-- ( -..0 ---------------- : ~ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .--/___ Number of bedrooms -A--- Number of baths __/-__ Lot size _c _______________________ Water Supply: Public system ❑ Community system ❑ Private ❑- Depth to Water Table _00 ft. Character of soil to a depth of 3 fee+: Sand ❑. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑Izill. 4 Previous Application Made: Yes ❑ No 02XNew Construction: Yes ❑ o, 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------------- Distance from foundation-------------------.Material--------------------------------------------___-. ❑ No. of compartments...._.•--------------- ---Size----------------------------•---Liquid depth--------------------------Capacity....--- ------------- E � 1 Disposal field: Distance from nearest well------ Distance from foundation------- Q __:Distance to nearest lot line____ Number, of lines__________________f__ -____ Length of each line----- -_ ___.Width of trench Type of filter material_____�� __ .-Depth of filter materia ____ Total length_____.__I ______________________�__. padation st I line _`Seepage -it: Distan ;to nearest well--------- fro f ____-- - __-DistanC to neare Number of pits__--__.___f_-_ ___Lining materiae� _�.Size: Diameter____c��-._._____Depth---- , 14 __________________ 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----------------------------------------- ❑ Distanceto nearest lot line" ----` -----r-----`----------------------- ----------------------------- ----------------------•---------------------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------:------------------------------------------------------------------------------------------------ -------------11--------------------------- --------------------------------------------------------•----------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 and rules and regulations of the San Joaquin local Health Dis+ricr Si ned ---------- and/or Contractor) --------- By:------------------- - ---------------------------------------•------- (Ti+le] - ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. . - ---------------------------------------- DATE --------------------------------------------------- REVIEWEDBY ----- --------------------------------------------------------------- ---------- DATE---��-----------------------•-•-•--------•-------------- BUILDINGPERMIT ISSUED------------------------ '- ------------------------------------------------------------------------ DATE.----- .,,. Alterationsand/or recommendations:----------------------------------------------------------------------------------------------- ---•--•----------------•-- ----------------•------------------- i -------------- ----- ,, ----- -----------•--------- -------=--•----------•------------•-••_--------------------------------------------- Date------------------ FINAL /I fINSPECTION 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 ES-9-2M 0-52 Revised W-2100