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+ APPLICATION FOR SANITATION PERMIT Permit No. ..S�.o_---J _ (Complete in Duplicate) 9 Date Issued Applica+ion 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 No. 549. OCATI N.1 - ----- --------- -h ._v JOB ADDRESS . -_-- - Phone.-------- ---- Owner's Nam Address............ -------------------- a -------------- ---- ------r------------ ------ --- ---------------•---•••---•---------••--••---------------•----- ---------------------- Contractor's -� - ------------=---=---=---- -- ------ -- Phone--------------- Installation will serve: Residence�Apartment House'r[]� Commercial ❑ Trailer Court ❑ Moti[] Other ❑ Number of living units: __I____ Number of bedrooms ____I__ Number of baths----- Lot size -------7.,Y - )__1 [) -- ----- ---------------------- Water'Supply: Public system Community system ❑ Private ❑ Depth to Water Table ---- ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ "Clay Loam E] Clay E] Adobe Hardpan E] Previous Application Made: Yes ❑ No-\iitL New Construction: Yes JK No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r)AA �Distance from fo ndation._ "`•---Material------ eptic Tank: Distance from nearest well?_-__ No. of compartments_.._--: __.5ize__ _ -------------Capacity____ - ' Liquid depth '- Disposal Field: Distance from nearest we �'yc.l�Distance from foundation___.!--_--------.Distance to Weare t �of lme__'. ---____. Number of lines___-.-_____ Le gt.h f each line____-' -- 4: Width of trench-- - Type of filter material-_ 4 ---------------- �,- � 'Iter material...- �_ - -------•_.Total length------- __ - ------------- ::---------- Seepage Pit: Distance to nearest well__.-__ __--__Distance from foundation____________________Distance to nearest lot line__________._____- - ❑ Number of pits--4 ------ ----Lining material---------------------.Size: Diameter------- ------Depth------------------------ Cesspool: Distance from nearest well----------------- from foundation.-------------------Lining material_____-._______--_--___-______- ----- Size: Diameter-_- ` Depth ------------------------ ------------------Liquid Capacity-------- ------=------------gals. Privy: Distance from nearest welt.__._..._____-----------------------------------Distance from nearest buildin ❑ Distance to nearest lot line______________________ _________ Remodelin and/or repairing {describe):___ q,� - --- --------�---- - ------ v ---------- ----- --- ----- -••------ -------- -1-----------------•----------------------- --------------- -•-----------•- ----------------- • -------•- . ----- ------------ ---------------------------- - - --- - - - ----------- -- --- -- --- --- - -- - I hereby certify at I have pre ared this application and that the work will be done in accordance with San Joaquin County + ordinances, State s�;.afnd-ruEees pa d regulations of the San Joaquin Local Health District. 5i Wed ---------- ' ----- ------- ------------- -----------------------------------(Owner and/or Contractor) --- - - By-------------------------------------------- _ (Title) - - ----------- ------------ --- - - - ------ _---- --------------- ---------•- -------------------------- ------- - -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Y e FOR DEPARTMENT USE-ONLY- APPLICATION ACCEPTED BY_'. -___ r-- ---- .__ . r y---- ` -REVIEWED BY ------- DATE----BUILDING PERMIT ISSUED----------------- ----------------------- ------- - ---- DATE.- ------ •:"*c :- -----------•--------------- _________________Alterations and/or recommendations_ - -------•----------------------------------------------------------•----- - ---------------------•------ --------------- -------------i- ------------------------- --------•---------------------- ---------------------------------------------------------------------------- FINAL -� Z FINAL INSPECTION BY: Date = --------------------------------------------------- SAN - - - ------------------- 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 ATWODp