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APPLICATION FOR SANITATION PERMIT Permit No. "" _ './-,L (Complete in Duplicate) , 4 Date Issued �_-- Application is hereby made to the San Joaquin Local Health District for a permit to cans ruc ani i�t I he wok herein described. This application is made in compliance wi h County Ordinance No. 549. -- ---------------------- --- -j---------- ------ -- JOB ADDRESS LOCATION _ -----_ Owner's - ------------------------------------- Phone ---•---- --- ----------- D - ------------------------------------------------------- ------------------------------------• ---------------- Address- Phone----------------------------------- Contractor's Name---- -----•- -• ---------------- --- --- ---------- --------------• --------- ---------- , dence �Q partment H [:] [IE] ❑ Elouse Commercial Trailer Court Motel Other Installation will serve: Resi �I -- + Number of living units: .. __ Number of bedrooms "_Number of baths __. - -------------------------- -'Lot size ___""F_- '7# '� 1 Water Supply: Public system ❑- 'Community system ❑ Private ]< Depth to Wafer`s Table E] Gravel E] Sandy Loam.❑ •Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand a Previous Application Made: Yes ❑ No New Construction: Yes No ❑� , I TYPE OF INSTALLATION AND SPECIFICATIONS: '' \\ (No septic tank or cesspool permitted if public sewer is available within 200 feet.} � +� Septic ank: Distance from nearest well"""-+/_-0_--Distance frondn" _�- -- Materi L , :I size ++ Liquid depth rCapacity No. of compartments------__-�7^ T� Disposal Field: Distance from nearest well""._�"" _.-Distance from founJ��gp-----/. -------- Distance to nearest lot line"" -- Number of lines-------- - Length of each Line_'°_` &I�.------At Width of trench_""--fes— ---- ---. Type of filter material__S �epth of filter material__---__-/4 o------- Seepage length!_""""- Seepage Pit: Distance.to nearest wellDistance from foundation--------------------Disiance to nearest lo ----------------------- t ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining - material_Ys--.--=--___---------___--^.---.g_---l-s-•. L3quid�Capaci Sita: Diameter ----De Depth ------- - ---„ �❑ , -- , ”"--..._""--- _"-."Distance from nearest building-------------------------------------- ; Privy: Distance from- nearest well------------.------ ------ ❑ Distance to nearest lot line-_-- ----------- r' " - - s _ ------------ Remodeling _ Remodeling and/or repairing (describe):_" --- ----------•------ -------- s - /� .� ------------ ? / I hereby ce ify that I have p,�Paced this applicatlion and thoj at the work will be done in accordance with San Joaquin County 4-2Y-ordinan s, tate laws, and rulest'and regulatio of the San Joaquin Local Health District. -.--_--(Owner and/or Contractor) (Signed)M .. - --•------------------------------------------------------.- :- )Tlt e (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). (. FOR DEPARTMENT USE ONLY ----------------------- DATE------------------ --------------- APPLICATIONACCEPTED BY--------------------------------------------------------------------- REVIEWED BY----------------------------------------------------------- --- ----- - ------- --------- ------------------------ DATE------ &__ __----- -------------------------------------- BUILDING PERMIT ISSUED---_-------------------------------- ------ -- - - ---------------------------- DATE--------------------------- -------•---------------------- Alterations and/or recommendations: -/7---- 7--- -_ r, -�.� ---� �+ ------------------ ------ ••-------- - -•-------------------- r t F �, --------------------------- -- --------------------------------------- ------- �._r. �� . -. . - ------ `---- -•-•---_ ._-------------"-•_•_------...-_------------_----•-------_--__----•- FINAL INSPECTION BY:--------- --_ --_---- _" Date--------- ------ .l- ------------------ ---- -4*------- SAN JOAQUIN LOCAL HEALTH DISTRICT Soo West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. r ES-9-2M 10-52 Revised W-2100