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i APPLICATION FOR SANITATION PERMIT Permit No. _..9__ (Complete in Duplicate) a� �+ " Date Issued Application is hereby made to the San Joaquin Local Health District for a'permit to construct and in tall the work herein described. This p 1�� is in comp' n with County Ordinance No. 549. ' J B 1 2a (A�DDR S AND LOCATION - -- Name-_ 0 4--- .4 ----------I------------------ -_ -- ---- - Phone.--------------------- - 1 Address-----------Q4�,-- �''t� f Contractor's Name----------------------- ------------• ----------------------------------.-•------ -•---••----------------------- Phone---------------------------------- Installation will serve: Residence' Ap tment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ .-___ Number of bedrooms Number of baths -_I--_ Lot size __..!__ .___ - Water Supply: Public system ❑ Community system ❑ Private W Depth to Wafer Table __-�[`- ft. a Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand Loam Clay Loam Clay Adob I ❑ Y ❑ y ❑ y ❑ e ] Hardpan ❑ Previous_Application Made: Yes ❑ No New Construction: Yes No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) "l Septic Tank' ante from nearest well-----------------Distance from foundation__________________ Material________-__--____ ' ❑ of compartments----- --------------------Size_------------------------------Liquid depth--------; ---------Capacity---------- Disposal Field: istance from nearest wellDistance from foundation__-_ 0 �. __._ 40---__-Distance to nearest lot line_______-... Number of lines_________ _______________________Length of each line----- ,0__0-il-__-Width of trench-_ - _-- -_--_______-.___ Type of filter material_ - ]epth of filter material______ _ ________T -Total length__-_______— --------- - Seepage Pit: Distance to nearest weal----------------------Distance from foundation-------------------Distance to nearest lot line----------------- ElNumber of pits----------------------Lining material-----------------------Size: Diameter--.--------------------.Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---_-_.________--_-____---__________- 5-ize_Diameter ----------------Deroth------------- •---- ----- ---------------------Liquid Capacity----------------------------gals. LL Privy: stance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------_. ~ �all� D stance to nearest lot line--------- ------------------------------------------------------------ � t t Re ar epa'ring (describ ): -+--- -_ �±f�41 __ 4-41— .. ___-- ? A -------------------•--------.------- ----------------- ------------------------- ----------------•----------•-----•----- --------------------------- --- ------------------------------------------------------------------------------------------------- ---------------------------------••----------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ordinances, State laws, and rules qnd regulations/6-1,the San J uin Local Health District. , .. - =- - - ---------------------------------- ---------(Owner and/or Contractor) =., BY: ------------------- - - ------f,` ------------------------------------------------(Title)-------------------------------------------------------------- (Plot plan, showing size of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------------------------------------------------------------------•------------------------ DATE--.---------------- - r REVIEWEDBY----------------------------------------- ------------------------ ---------------------- BUILDING PERMIT ISSUED DATE ---------------------- Alterations and/or recomme dations:----------- _ -- ___-- ------------------.-•-•-•-------------------•-----------. -•-- ------------------------- ✓t.�,f: '1e�.../ - 4-�, ---------------------------------------- ----------------------- ---------------------------------------------------------------------------------------------------------------------_--------------------•--------- ------------------------ FINAL INSPECTION BY-------------------------- --- ---- -- Date------------//�"_ � 'S-3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100