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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Apphc a+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. liance wifih County Ordinance No. 549. This application is made in comp IN + C.- JOB ADDRESS AND O -- --------- - -------- -----•-- -------- -----=------------------------------------- Phone Owner's Name______ -- P .. Address. Z -3 �° ------ -- - - -----------------------------------------------------------------------•----- Ph n "" e"- �04G --- ------------------------- Contractor's Name.___-.j artment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence �p ❑ - f ---------------- Number of living units: _ --- Number of bedrooms -------- Number of baths -------- Lot size .." Water Supply: 'Public system '❑ Community"system ❑ Private lZ Q.pth to Wafter Table _`70 ft. Character of soll to a depth of.3 feet: F Sand E] Gravel ❑ Sandy loam El Clay Loam❑ .Clay ElAdobelardpan ❑ Previous Application Made. Yes-I-] No New Construction: Yes ❑ No [�---- � , r TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) '1 ' !_.Material -- ------ ------------- -------------- �. Septic Tank: Distance from nearest well__-_{]Q---Distance from foundation__-""� Q ( w___Ca Capacity 5�------- No. of compartments----------�..---------Size-" - - d--- Liquid depth____-V"C- p Y--- �_47_"-_-Distance to nearest lot line---6----r----- j Disposal Field: Distance from nearest well---rr.0_'.-Distance from foundation___-s Width of trench__ _�`-----.-.----------- Number ---- -----Number of lines---------- -7�_,__p_"""---Length of each line--------- � t- Total length________-�__`_____- r� _ De th of filter material___-_ ------------ Type of filter material--/_L------"- -- p Seepage Pit: Distance to nearest well------49a-_� Distance from fo ndation___._�Q." Distance to nearest lot line----- o pits_- -_ Lining material____ ---Size: Diameter___3_3--- ......Depth-____.Z_0- ----------------- Cesspool- Distance from nearest we1L________________Distance from foundation-_-.----------------Lining materia_____-_----__________--_-._------- _ Size:.Diarneter--- -------- Depth_ = "� Liquid CapacitY_- =- x Dancer _Distance from nearest buildin ❑ rorn nearest ural) g------ ------------- ----- Privy. ❑ Distance to nearest lot-line----------------------- ------ 1 n. r i Remodeling and/or repairing (describe):---------------- ----------------- `------ ------•---------------------------------------• ----------------------- ---------------------- ----- ---------•-•-----------q.."--- --y,., i 16 -- = -•-------------------------------------=--------------•--- --------; , --------------------------------- - ----------------------------=------------------------------------------------------------------------------------•------------------------ 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 Local Health District: ' t -- ontract (Signed)---- ---T --- --- --------- I (Title) ----------------------------- (Plot plan, showing siie of lot-- location•of system in relation to wells, buildings, etc., can be placed on reverse side). y1 FOR DEPARTMENT USE ONLY H. .-� ----- APPLICATION ACCEPTED BY---- ------------------------ - -- --- --------------------- ---------------------------------- DATE-------- ----- - �T - - DATE---------------- ----------------------------------------- REVIEWEDBY-------------------- -. -------- ------------- BUILDING PERMIT ISSUED.:-------------------------------- ---------------------- --------------------------------• --------- DATE-- --- •--------- --•-------------------------------•-------- Alterations and/or recommendations---------------------------------------- ------------------------- _ ---------- ------- ---- h -------------------------------7---------------.--.--.--.-- -----_- --------- --------------------------- -------------------------- - ---------------------- ---- -- -- -- - --- Date.------- ---------- -CT INSIDE BY.I' SAN JOAQUIN LOCAL HEALTH DISTRICT 7 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street� Tree California Stockton, California Lodi, California Manteca, California y, ES-9-2M ; Revised W-21,00