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APPLICATION FOR SANITATION PERMIT Permit No________ P- _ y' 14. ri (Complete in Duplicate) �f Date Issued Applica-lion 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 S49. JOBADDRESS AND LOCATION-.-----------Z------------------------------------------------------------------------------- -- ----------------------------------- Owner's Name -------- j --------- ------------ --------------- ------------------------------- --- Phone --------------------- ------ -- J __ t Address ------------------- Contractor's Name----- Phone_3„� 2 �_� Installation will serve: Residence %111'�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ Number of bedrooms _X__ Number of baths :_1-__ Lot size ___�r7__.___/•,:--___- ----------------- Water Supply: Public .system ommunity system ❑ Private ❑ Depth to Water Tablet/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: Yes ❑ No P�lew Construction: Yes ❑ No [g-- TYPE OF INSTALLATION AND SPECIFICATIONS: -� (No septictank-orcesspool permitted if public sewer is available within 200 feet.I Septic Tank: Distance from nearest well ------------ Distance from foundation -------------------- Material __._______-._____._____._---_______...___-.____. o�of.,:compar.-men:hs..��. Size. --Liquid depth-------------- ��__�_._..._.�-•-•- ------------ peaty -------------------- D i5posal ----- ------------Disposal Field: Distance from nearest well_____________ _Distance from foundation______..__ --_____._Distance to nearest lot line ----------------- Npmbe f lines __^= Length of each line Width of french--- -------------------------- - Type of;{ilter material---------1--------------Depth of filter material - l l -------------_-------Totaength-------_-_-----•---------------------_-__ Seepage Pit: 'D -stance to `nearest welly-rI Distance om fo ndation____ -f__.-_.Distance to nearest lot line__-- Numer of its- % ----- ._ -_ f �' _ - r ,fir bp - -- -,---I Lining material--- --- ------ -- --Size: I3iameter__�Z----------- Depth---��'--'------------ ----- Cesspool: A s siana from nearest well -.._-----_._:___Distance from foundation ____________________Lining material-__._ ❑ .� Size: DSameter--------- Depth ----------------- ----------------------------Liquid Capacity ---------------------------- gals. Privy: f Distancl from nearest well_________':Distance from nearest building z- ❑ - Distance to nearest lot line ------------•---------------------------------------------------- -- Remodeling and/orrape ri iri i gr{dri}�e}:--_------------------------------------ ------------- ------------------------••----------•-------------------- •----------- -----••----------------•------ •-------:f-----------•-----------.---------•---------------------•---•--------------------•----- _ ------------------------ --------------•-----------•-----------------------------=----- ----------- -----------•-------••----------------------------------=--•---------•-------------------------- -----------------------------------•---------------------•----- -----------------------------•------ I hereby certify that I have prepared this application and that the w rk will be done in accordance with San Joaquin County ord, tateinanceslaws, and rules a-,Td'FegJlaiions of�fh"�W-Jo�fff-Loc l Health District. (Signed)- -- ----- - ---- - ------------------------=- ------ ----- -- Contract ) --/-`-- --------- BY� L - ------•----------- ------------------ ar (Title) -------------- ----- -- - - - - -------------------- ot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - w DATE. REVIEWED BY-------------=----------- ' DATE-------- - . .... . --------- ------------- -- -------------------------------------- 1 - BUILDING PERMIT ISSUED._.. ------: ---------------------------------------------------------------- DATE..-- •--------- •---- ------- --------- - - - - Alterations and/or recommendations-------------- --------•- -- ------ l? r .-..__ ___ _ - -------------- -- _____________________________________________»_-„__-___..-..-____._-,______._-___.___---.__._._--_ FINAL INSPECTION BY:..__�--_ �1�.%_. . ---------------- Date -----f--- .-------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M : Revised W-2100