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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to const uct and install the work herein described. This application is made in compliance with County Ordinance No. 549. r? JOB ADDRESS AND �LOCATIO - ---- - -------------Q`-'_-y---�--h-�- Owner's Name - --------------------------------------- ----- ------------------------ Phone Address-------e-.--o- Z---- r ---------•---------------------------------- -------------------- -------------------------------------------------------------------------------------•--•- Contractor's Name--------- ------------------------------------------------------------------------- Phone----------------------------- --- will serve: Resic1 nc Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.INumber of bedrooms _�_ Number of baths --#--- Lot size ------/�_�__ __�>,SC�______________ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table __9___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe q Hardpan ❑ Previous Application Made: Yes ❑ N0)4 New Construction: Yes A No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,fiy�� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i' Septic Tank: Distance from nearest well____ ___Distance fror] foundation____ �_Q---------.Material- ___ _ No. of compartments--------X------------ ---Liquid de th--------_-4-----------Capacity---- Disposal Field: Distance from nearest weli---6-5_-___Distance from foundation____19_____-Distance to nearest lot line d _ _ Number of lines______________2-_ Length of each line---________. r,!______wdth of trench__-__--•3p______________--- Type of filter material___��-'� epth of filter material--------/---Ce------Total length-------J--. ._(r?_______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- �1 Cesspool: Distance from nearest well________________Distance from foundation__________________.Lining ------------------------------------ 171 .I Size: Diameter-------------- -----------------------Depth------------------------ _ ---- ------Liquid Capacity Privy: Distance from nearest well________________________________________________Distance from nearest building__________________________________.____ ❑ Distance to nearest lot IlineF,� ----------------------�----------------------------------------------------------------------------------------------------- Remodeling ------------------------------------ Remodeling and/or repairing (dascribe)___ __ ___________ °` _____ �_ ' ® - ---- ` 1. ` r-------------------- -- ----------------------- - ---- ------------------------- - ------------------ -� 1 .-' - --- r-- --- ------------------------------------- --------- -I-- - ---� ----- - I hereby certify that I have prepared this application and that the work w' be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. [signed) •+ + ---------0x--- --------------------------------------------------------------------{Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Tifle)---------------------------------------------------------------- (Plot plant, 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 BY---------------------------- --- DATE---------------- REVIEWEDBY-------------------------------------- - -- ---- ------ -----------------------------------• DATE-------- - BUILDING PERMIT ISSUED----------------- - DATE =- - - - - Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i FINAL INSPECTION BY:-------------)V�?0-4alkDate------------- ----1` —Z -7 - -- -------------------- I 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 8-51 Revised W-2100