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APPLICATION FOR SANITATION PERMIT Permit No. ..C�°_ S�_.`_--... (Complete in Duplicate) ,Z—, �� Date Issued I......-.-�.�------ 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. JOB ADDRESS AN OC TIONC ✓ j - ----- -------a ---------------' - Owner's Name - � •-•-•-------------------------------- - ---------------------------------------- ------ --: .---:__Phone, ------------ -- -------------- pp i Address .. -- --------- - - --'------------ -----------------•-------- -------------------------------------•----•---•-------••------------------------ -i Contractor's Name------------------- ---------------- -------------------------- ------------------------------------------------------------------------ Phone-.------ -------------------------- i Installation will server Residence 0 A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __j----�.... umber of bedrooms __-_ umber of baths ..., --- Lot size _-----��______________ Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table 1-97. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeb( Hardpan ❑ # Previous Application Made: Yes ❑ No New Construction: Yes ❑ No9 ; TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ' Lance from nearest well.................Distance from foundation--------------------Material------------------------------------- ._... ❑ N. . of compartments-------------L----� Size -----------Liqd- epfh--------------------------Capacity------------f�-- Disposal Field: r istance fromnearestwell....7` -__Distance from foundati n..._ _ --_...:Distance to nearest lot line----------------- �mbe! of lines-------- f ngth of each line Width of trench --------- Type of filter material._.. e th of filter material_..... .�.---._Total length �............................ Yp , -�------------ p 1 Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------.._...Distance to nearest lot line------.--------_. a ❑ Number of pits----------=------------Lining material-----------------------Size: Diameter------ ----------------Depth---------------------------------- Cesspool: Distance from nearest well------------------Distance from foundation................... Lining material --.........__-.____.------.--------- Size: Diameter-- -----------------------------------Depth----------------------------------------.---- --Liquid Capac.ify------=------------------ gals. _ .3 ❑ r Privy: Distance from nearest well--------- ---------------------------------------Distance from nearest building........_...----------_.._...________--- I ❑ Distance to nearest lot line-------- ---------- -------------------- - ------------------------------------------------------------------------ ------------- ! Remodeling and/or repairing (describe) �-------------------•----------------------------------------------------•---------------------- I r ------------------------------- ---- 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 ru s and regulations of the San Joaquin Local Health District. I (SignedP11 - ----------------------------------------------------- -------------------------(Owner and/or Contractor) ,i By:--------------------- ------------------------- ---------------------------------------------- ----------------------------(Title)----------------------------------------------- ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed'on reverse side). FOR DEPARTMENT USE ONLY I r APPLICATIONACCEPTED BY-------------------------------------- ------ ---- -- - --------------------------------- DATE----------- �---- ---- - REVIEWEDBY ------------ -------------- - - - -'------ ------------------------- DATE �. -r ,a ; jZ --------------------------------------- BUILDING PERMIT ISSUED------------------------------------- --- - DATE - Alterationsand/or recommendations:---------------------- ------------------------------------------------------------------------------------------------ -------------------------------------- ----------------------------------------------------•-------------------------------------------------- ------------------------------------------------=------------------------------------------------------- ---------I---------------- --------------------------------------------- ------------- --------------------------------------------------------------------------------- ---•------•--------`-- ----------------------------------------=•----------------------------- ---------------- --------------------- ------- --------------------------------------------- --------------------------------------------- I BY:.------- ------------------------ Date......... --- �----------------------�--------------------._. FINAL INSPECTION . 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 10-52 Revised W-2100