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Permit No. �-�-� --- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 2 Date Issued Application is hereby made o the San Joaquin Local Health District for a permit to constr ct and install the work herein described. This application is made in compliance with County Ordinance No. 549,4 J yam!` ------------------ i JOB ADDRESS AND LOCATION--------- - ` - -----'.------------------------------------------•--------- Owner s Name-------------- ---------- -�- -------------------------- Phone------------------------------------ e --- ----- Address � . _ � ----------•-------. ---- -- --- --- - --- �. �- - - , ------- Phone Contractor's Name_ - . --------------------------- ---------------------- - --- -- �. Installation will serve: Residence Apartment House ❑ Commercial ❑ ..Trailer. Court ❑ Motel El Other El_ _ Number of living unit : ___ Number of bedrooms _ __. __ Number of baths ___ -Lot size _ --------------- Water Supply: Public systeln Community system 'El Private ❑ Depth to Water Table ________ ft. Character of soil to adept Illof 3 feet: Sand El Gravel El Sandy Loam Clay Loam El Clay E] Adobe lardpan El ❑...' Previous Application Made: Yes ❑ No Ar-""New Construction: Yes i TYPE OF INSTALLATION �ANR SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within'200•feet-) �I Distance from foundation___----------.Material-_-- - -- - ---------------- Septic Tanks Disfiance� from nearest well - -__Capacity-,. No. of compartments--------------------- - Ze Liquid depth f 6-----------Distance to nearest to I�e__ ___-.____. p Fie Distanc0 from nearest well�!�_____ --Distance from foundation_ __ I Numbe%of fines___ Len th of each line___-- � �------Width of trench---- - --- -------------------- Dis oral --------- - g �� / ---- -Total length Type of;filter material-�'�j�__ ..% -Depth of filter material__ ___ _____ I: Seepage Pit: Distanc.l� to nearest well____________________ Distance from foundation____________.------Distance to nearest lot line_________________ ❑ Number.of pits---------------------Lining material-----------------------Size: Diameter - -:Depth qCesspool: Distance frorn nearest well-------------__-Distance from foundation--------------------Lining materEaf-------------------------------------- Size: D.rameter----------- ---- 7------------Depth--- ------------------------ ------Liqu•sd Capacity- ------ a 5 --------- - _ r:--- Y_ _____ Distance from nearest budding__ Privy: Distaannclh f om nearest well_:__ --- - ❑ Distan le to nearest- lot line--------- ----- --- ------ --- --- --- -- -------- . Remodeling and/or repairing (describe):_____--____ -'----- --- ------ -------- r ------------------ ----------------------------------------------------•-------------------------------- ------------•------•--- --------------------- -------------- ---------------------------------------------- -------------------------------------------------------------------------- - -- -------------------------------------------•----------------------------Z------------------•------------------------- ------------------------------------ ----- I hereby certify that lhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a r le nd regula ' n f the San aqu Local H alth District. ti i , II - -- --------- (Ow�nd/o infractor] (Signed)----------- -� - -- ------ ---_ -- ---------------(Title)----- (Plot plan, showing size of slot, location of system in relation to wells, buildings, etc., can be placed on reverse side). oil �p FOIL DEPARTMENT USE ONLY p � APPLICATIObf ACCEPTED BY ----- -------------- -------------•------------------------:------ DATE_- f- ---- , ------ ----- REVIEWED BY illi - DATE-------� ' BUILDING PERMIT ISSUED-------- ----------- DA �L ----------------------- i� Alterations and/or recommendations:_ ------ -------------- ----------- -- --- -------•-----------------------------------------------------------------------------•--•------------- -------------------------------------------------------------------- ----- ----------------------------------------------------------------- ---------------------------------------- -- - - - ------ ---------••-------- ---------- Z**7 F1NAL INSPECTION BY:____ ____.___ Date ---•------------------------------------- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+rIB_et 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California II Lodi, California Manteca, California Tracy, California �l ES-9--2M 8-51 Revised x,2100 In � �