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L APPLICATION FOR SANITATION PERMIT Permit No. _ .... (Complete in Duplicate) / Date Issued _6-�1-5. 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. r JOB ADDRESS AND LOCATION-__ _. .____._ ---- Owner's Name--- // les----- ---- ---- ----- --- ------ -- -----------------------...------------------------------------------- Phone----------------------------------- Address . �._.... -- - ------------------ 11 +� Contractors Name----------------------•. -_ Phone_-- .-------� -- "� � lnstallation will serve: " Residence �partment House,, Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.L_. Number of bedrooms __a__ Number of"baths ---� Lot size _-'___----.._-.-_ Water Supply: -PublicA sysfem.4_,�mmunify system❑ Private ❑ -Depth to Water Table IA-ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EI'7rardpan ❑ Previous Application Made: Yes ❑ No 91(. New Construction: Yes ❑ No 2 — TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation_----____-__--_. Material------.__-_--..--_--__.._-----__-__-_-----._...('� No. of compartments------ -------------------Size--------------------------------Liquid depth----------------- --------Capacity------------------- W i Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line------------ Number of lines--------------- -- ----------------Length of each line------------------------------ .-... Type or filter material-----___________________De Depth of filter material____------- -Width trench_________________.__.____-_--__ - - Ypp -----------------------Total lengfh--------------------------- ,_ r Seepage Pit: Distance to nearest well4_1*t_v. r____DistanceVfo foundation..... ._.___.Distance to nearest lot iine__l. Number of pits.--.--_--)_---_-_---Lining maferial -A-_--_._Size: Diameter__�AO--- Depth._�,f'_ a__�_'_____.____. Cesspool: Distance from nearest well-__---__-_____--Distance from foundation--------------------Lining material--.---_--.__-----_--_------_--_-_--- ❑ Size: Diameter------------------ ---------- -------Depth----------------------------------------------------Liquid Capacity-.---------------------------gals. Privy: Distance from nearest yell-------------------------------------------------Distance from nearest building--------------------------- -----. ❑ Distance to nearest lot line-- --------------------'..---------------------••-------------------------------------------_------------------------------------------- -- Remodeling and/or repairing (des vibe):_-ice- f- - ��^ -- -�----------� k----- ----IV-------------------- -- �----- --.wi4 -- ---- 0-0-10- +fte ------- - –1�--�------------------ s ---------------•--------------------------------------------------=-----------•--------•---------.-----------------•-------------•-----------•-----------------------------------------------•-------------------------------- 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 LocaFHealth District. (Signed) 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--------- ----------=-- -- ------ REVIEWED BY--------------------------- ---- •-------------------- DATE----------------- -�-�a <--� -•�------- --- BUILDINGPERMIT ISSUED---•------------------------------------------------------------------------------------------------- DATE--------- --------- Alterations and/or recommendations:------------------------------------------------------------------- •----------------------------------------------------..----------------------------- ------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ----------------------------------------- ----------------- --------------- ------------------------------------------------------------------------------------------------------------------------------- a " -------------------------------------------•--------------------------------------------------------------------------------.------» . ----------- ---------------------------------------------------------------------. FINAL INSPECTION BY:�W_ _er, -__. Date--- J__w-------'l------ ---`------- -............... r. 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