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APPLICATION FOR SANITATION PERMIT Permit No3_Z.6---7----- (Complete in Duplicate) 1 Date Issued 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 CountVOrdi ;nce No. 549, �ooys. c-.4�ao sr 13-� o r� JOB ADDRESS AND LOCATION_ _ __. Owner's Name- / - -------- -• -- -- ------- ------•---- ---------- --- P ne-- --�-� .� 001 Address_-_-------- - ---------- �:P �' _ `._r__ ___ ______________________________ Contractor's Name - ---------- ne. Installation will serve: Residence ❑ Apart ouse ❑ Commercial ❑ Trailer Court ❑ /Motef,n� Other ❑ Number of living units:j�.._- Number of bedrooms_ Number of baths /___ Lot size ___ o U_________________- Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table e- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe ElHardpan 0 Previous Application Made: Yes ElNok New Construction: Yes ❑ Nom. Q TYPE OF INSTALLATION AND SPE IF (CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)_aeV? pptiic,Tank: Distance from nearest well-----------------Distance from foundation-------------------_Material-.---------------------------------------------- f 1 No. of compartments---------- - - -----------Size--------------------------------Liquid depth--------------------------� Capacity-----------------J Disposal Fii d: Distance from nearest well_�r_�_ ___Distance from foundation _.�_____.D�fance to nearest lot li�_ _ m Number o-i lines______-._)------_-------- -----Length of each line______ _ _______..Width of trench-____�_____---------------- la . _ ---------- Type of filter material _ ____ p _____Total length_________- __ ------=.De Depth of filter mater:a!___�_ __._-_ .4Z-0 __________________ Seepage Pit:" Distance to nearest we€€----------------------Distance from foundation--------------------Distance to nearest lot line-------------- 11 -._-- -_-_❑ - Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------- ----------Depth----------------------------------- - --------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____.._______-_--______-_-_____-._. ❑ Distance to nearest lot line------ - ----------------------------------------------- ------------- ---------------------------------- ------------- Remodeling and/or repairing (describe):------ - --- ---- �� = ------------------- -- ---------------------------•------------------------------------ --------------------------•---•••--------------------------------------------•-------------•------•--------------------------------------------------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, Statep1s, d r a regulations of the San Joaquin Local Health District. Sined ----- �------------------------------- (Owner and Cantracto9By:------------ 2•----- t ------------------------------------------------------------------------------(Title) ----- . .------t--------- - -- -- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p6jora on reverse sib! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE ------------------------------- ----------------- REVIEWEDBY------------------------------ --- - ------- -- ------ ----------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------- ---------------- DATE_-------_V-------------------------------------------- Alterations and/or recommendat ions:---------------------------------------------------------------------------------------------------------------------------•-•--------•------ ---------------- ---------------------•--------------------------•------------••----------------------------------•--•------------------------------------------------------------------------------------------••.................. ------------------•-----------------------------------------------•--•----------------- ---------•-----------------------------------------------------------------•-------------------•----------------------------------- ----------------------- - ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINALINSPECTION 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