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APPLICATION FOR SANITATION PERMIT Permit No. ---____-- �/ (Complete in Duplicate) 5 Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and 1 _70—0 work herein described. This application is made in compliance*with County Or mance No. 549. �c2s S• AS t_ r78.eg dfl ST JOB ADDRESS AND LOC4T Y ------------ _ ... Owner's Name+ ----- ------------ ----------- Phone--------------------------- ---------•--Address ?. ----------------------- lg.t��`� I; Contractor's Name Phone -----------1 '`.--.'... Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ M tel ❑ Other ❑ Number of living units: _. Number of bedrooms . __. Number baths ---I--- Lot size ____---- __ ___________________________________________ Water Supply: Public system Ll Community system ❑ Private Number to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe I] Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes 0/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if 'blit sewer is available within 240 feet Distan fr fo dation. ..- Septic ank: Distance from nearest well::___ __-_ _ . l (___��f'erial_�, I-------------compartments--------- ----------- ----- Capacity---> 49-ft----- Disposal Field: Distance from nearest w ILDistance from foundation/p_____ '" Distance to nearest lot line.- [� 41 Number of lines__________ -1- __-.___._. Length of each line____________ _Q __-Width of trench_.-.__ ____ _ _--_--- D yy� Type of filter materi _ _ epth of filter material Ci_-_-__-_Total length________ d _____.Distance from foundation____________________Distance to nearest lot line_______.________- N Seepage Pit: Distance to nearest well---------------------- � ____.Linin ' material__________________-__-Size: Diameter_______.----.-._ ❑ Number o pits 9 Depth .... Cesspool: Distance from nearest well-------------_ -Distance from foundation_--.---------------.Lining material-----_-__________________________-- El Size: Diameter--------------- -----De th--------------------- ------------Liquid Capacity ale. w, 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 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. (Signed)....... -------------------- -----------------------------------(Owner and/or Contractor) BY. •------------------------------••----------••-•--•--•-------------------------------------------------------------------------------(Title)------- - -- ------------------------------------------------ (Plot ----------------------------------------- - (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 B - ---------------------------------------------------- ----------------•------._.....---------- DAT REVIEWED BY DATE- ----- --- --------- ---------- - ----------------------------------------------- BUILDING PERMIT ISSUED----------------------------------- ---••------------- ----------------------------------------------- DATE------�.---•------ Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------- ----------------------------------------•-•-------------------------------------------------------------------------...-•------------------------------ ----------L------------------------------------------ -------•- ------ ------ FINAL INSPECTION BY----------- -------------- -- Date-----___--- ___--- - r '�3 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 145446 A7wOQU