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r APPLICATION FOR SANITATION PERMIT Permit No. _..L '... (Complete in Duplicate) Date Issued j_'~ _f" "'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 CATfON.C�-R-----------_Q_ --------------;----------•---------------------------------)It Owner's Name-- - ------- "Phone---------------------------------- Address. l� ----•------ = --....-- 1. Contractor's Name------ - ---- --- ----------------•--•---------------- ---------------•- ------------------I------------------------------- Phone Installation will serve: Reside a Apartment House ❑ Commercial ❑f Trailer Court ❑' Motel ❑ Other E] Number of living units: --T- NGmber of-bedrooms _m_�Number of-b— s = _ Lof ::_= - Water n} Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ___,_,_._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan F] Previous Application Made: Yes ❑ No New Construction: Yes, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) " Septi Tank. Distance from nearest weil---/_�;__Distance fro ro,fo ndaation___1-0---------- ial__«__�_t_^_'�'"-'�'�_..�__ _��_.____. d No. of compartments_--___ "_________Size__ �__a?__ _ .__Liquid depth__________ __________C ----------- Disposal Field: Distance from nearestII_._.,-6-- __Distance.from foundation...__ __ _ ,D,istance to nearest lot Ine______ i Number of lines-_-------- ---------------------------------- ength of each line__o__'_ , "`,` lidth of trench---- ------ ---- ---- ------ Type of filter material___. ,_:Depth of filter material-----/__.__------Tota€ length____TX ----------------_------__ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line--------------- , ❑ Number of pits-__------ ------Lining material-----------------------Sizer Diameter--------:--------------Deptn----------.---------------------- V Cesspoo{: Distance from nearest well-----------------Distance from foundation___________________ Lining material------------------------------------- -____-- Size: Diameter--------- ------------------_------Depth --- --- ----------- • ---Liqui apacitY- -- ---ga s. Privy: Distance from-nearest well------------------------------------------------- from nearest building-------.___-_____________________.__..._. ❑ Distance to nearest lot line- -- -4. ------------- ------ ------- --------- Remodeling and/or repair ng [desc iber___.rr�"•�_ -____ ""--' �`-- .��--------'�� -- '� - ----------------------- ---------- `-- ------------- ------------------ ----._..: I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County+ ordinances, Sfate�laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----------�---------- ---- �' •- --------=:---- ------------------------------------------------------------------------------(Owner and/or Contractor By:-------•-------------------------••----------------------------------------------------------•------------------------------------(Title)--------- ----- (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 APPLICATION ACCEPTED BY-- --------- .._ -------------------------------- DATE s- --�REVtEVIW�ED--$Y_---=---_-�:_.�._=-__--=r____-..- T--=---=---T__°=_--=::-,-�-=-=-�—,�..,ks___:._D.&T -- - ------ ---�_ ---�_- --- ------- -_- - BUILDING PERMIT ISSUED-------------------------------------------------------- --------------------•-•-----------------.._. DATE-----------------------•-------- -------------------------- Alfer tion and/or recommendations:_-_.. _:_.__ ------------------- - " ----- ------- --- , - ------- --------- ---- - � . = ., .a•. -- ------ - -------------------- :-- ---- _ s x FINAL INSPECTION BY F 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 10-52 Revised W-2100