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APPLICATION FOR SANITATION PERMIT Permit No. 7 j (Complete in Duplicate) D ° ate Issued -- 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 mad in ompliance with County Ordinance No. 549. d --- JOB AD4JS AN LOCATION,--- - ----------------- ..�---------=-fit-- --- --- 1441-57---- 7 --- Phone-------1_I_1_� - Owner s Name------- --- _ -�...--- --- :-=e--- ------------------- ------------------------------------------ �_0.`---- Address------------------------ -------- Phone Name-----------------= Phone Installation will serve: Residence I artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms Q___ Number of baths___ Lot size -_________-_____ Water Supply: Public system ❑ Community system ❑ Private )( Depth to Water Table _ . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ - Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No ❑ TYPE OF IN57ALLATI AND SPECIFICATIONS: {N/& Disfance or cesspool permitted if public sewer,is avaiVablewithin 200-feet.],a.;:_.: :. r _Septic Tastance from nearest well_________________Distance from foundation________---'___.___.Materia.______________-_____,______-__________________.o. of compartments--------------------------Size__.------------------------ Liquid depth-------------------------Capacity-------------- ------from nearest well_________________Distance from foundation_--_______________.Distance to nea ------------ rest lot line________________umber of lines-----=-----------------------------Length of each line-----------------------------.Width of trench--------------------- T of filter material------------------------- Depth of filter materiael length------------------------------------------ ` / �------Di§tante fp Barest l ine__ ___- Seepage Pit: Distance to nearest wttell___ ________Distance o founds on____._ __ __ Number of pits---------f-----------Lining material- Cesspool: Diameter.- _ Depth---- -- - -------------------- y�' Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining _ l - mate rial-________-_____________-________ Size: Diameter--------------------------------------De th----------------------------------------------------- q -dCapacity -- --- --------------gal_s_. ❑ _ est building" Disrtefromnearest well----------------------------------------- ---- Distance from near Pri l describe :__�'-- ------------- -- ---------f------ -------- ---- Distance to nearest of me________________#_-__ o el or repairs ( ) ---- --------------•------------------ ----------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 District. ___ Owner and/or Contractor) -----------------------------------, ------ ----------------------- ------- -------- � ..�= ----------------------------- ------(Title): �- __ -(Plot plan, showing size of lot, location of sto wells, buildings, etc., can beplaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- --- -------- •- ------------------------------------ DATE--------- REVIEWED BY-------------- ---- - P DATE--____-- -- BUILDING PERMIT ISS.UED_____________________________- - „ :;;� ---------------------------- ------ DATE - ---------------------------------------------- ------ Alterations and/or recommend ations:-_____------------------ ---------------------- y ----------------------------------------------------------------------- --------------- __� �---------•-------•---- FINAL INSPECTION BY-------------------- --------- - Dale ` SAN JOAQUIN LOCAL HEALTH DISTRICT 132 $ camore Street 814 North "C” Streot 130 South American Street 300 West Oak Street y Tracy, California Stockton, California Lodi, California Manteca, California y. ES-9-2M 8-51 Revised W-2100