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APPLICATION FOR SANITATION PERMIT Permit No. .:1-�_��._ \ {Complete in Duplicate} Date Issued Applica+ion is hereby made to the San Joaquin Loca[ Health District fora ermit to construct and instal the �`qrk here4desi d.Thisapplication is made in compliance with County Ordinance No. 549. %,��j��7.796 k N Sh/ e�� . JOB ADDRESS AND �LOCATION ________ _ -------------------------------------------------------------------------- Owner's Name.... --- �` 1/1 �� Phone -------------- --------- Address- --------- ------ `------------------------------------------------------------------------- --------------------------------------------------------------- ----------------------------------------------------:-----••- - - .. Contractor's Name �J 'P t -..L' -C -----------------------=----------------- ---------------- Phone ---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms ___`__ Number -of baths "_�__ Lot size__�--'_________ Water Supply: Public system ❑ Co rnaify sy teTn ❑—PNv,ate �epth rto`Water Table _'*3_?__Fft- { Character of soil to a depth of 3 feet: Sand Gravel E]Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe IJ Hardpan_❑ ` n x Previous Application Made: Yes ❑ No .New Construction:- Yes ❑ No [R� i r � TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Y- ._ :. f Septic Distance from nearest well__&__ _____ Distance #fom foundation_ -__"_""_____..____.Mat riaf__________ __________________ _____________, No. of compartments------:--�~-"--Size-------------------------------- Liquid depth----- ----- -------- -Capacity ----------------- Disposal `--- / Dis osal Fi Distance from nearest w Distance from foundation Distance to nearest lot line .-_ p Number of lines_____ ______ll��y � Length of each line_______________ _ _._Width of trench ------- �f_-_____-___ Type of filter materiall- ----------- ----------- Depth of filter material_�________Total• length________.______b________________ r Seepage Pit: Distance to nearest well ------------- _-------- f Distance from'foundation____._._.__...:____.Distance to nearest'lot'line________________ Nurnber of pits ------------------'_- Lining material -----------------_---.Size: Diameter ------------------------ Depth -----.------- -------------------- �. Cesspool: Distance from,n:earest well --------------- Distance from foundation -------------------- Lining material ----------- .--------------- _ (]. _ Size: Diamete"r--------------------------------------- --------------------`--------t----.Liquid Capacity-_-----•- ---------- �--------- gals. Privy:; Distance from nearest well- __ _--__ _-_-_ __ _._Distance from nearest building---_ -------------------- --__--_. ❑ D.istance to nearest lot line_--"_ri- r^---= - -r_-------- -------------------------------- - --------------------------------------- --- ----- ------ Remodeling and/or repairing (describe): --------- -------- I-------------------------------- i ---------------------•-------•----------------------•---•---------------____•---=---•------ --- ------- ----•-----------------------•-•-------------•-----•----- ------•--•-- -------------------•------------•-•-------•----------------------------------------- ► t `' I I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and ie ulations 'f the San Joaquin Local Health District. t ____ Owner and/or Contractor (Signed) Aot. - __-------------------------------'. { - / I { BY:--i,ing ---------------=------------------------------------------------------ (Title)----------------------- ----------------------- ---------------- (Plot plan, size ofcationrof system in relation to wells, buildings, etc., can be placed on reverse side). "_-4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ---------- - DATE ------ REVIEWEDBY ------------------------------- ----------- r -------------- ------------------------------------------------ ----------------- DATE ------------------------------------------------------------ BUILDINGPERMIT ISSUED ------------- -----------------------------------------------------------•--------------=---------:---- DATE. ------------- ------ --------------------------------------- Alterationsand/or recommendations ------------------------------------------------------------------------- ------------------------_-_---------------------------------------------------- ---------- -------------------------------------- -------------- ------ ------------------------------------•------------------------------=---- ......... .......................................................... ----------------------------- ------------------------------------ FINAL INSPECTION -BY:.. Date----------==`= _" " 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 ; Revised W-2100