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APPLICATION FOR SANITATION PERMIT Permit No. .3__7_---. ..__ (Complete in Duplicate) 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 Cou ty Ord' nce No. 549. JOB ADDRESS D9CATT)�,OI- 7-----------------------------------------------------c ._ ------ ------------------------------------ Owner's Name ; ------------------- ---------------------------- -- - Phone _'"_ � f� Address-------------- �j `� - Contractor's Name---- -------- ------- Phone---------------------------------- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel EIOther ❑ Number of living units: __I---- umber of bedrooms -- � Number of Baths _�___ Lot size ._ -.0�?C__ ------------------------------------- C ' Water Supply: Public system [1� ommunity system ❑ Private ❑ Depth to Water Table ________ ft. Characterof soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam E] Clay E] Adobe �ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ;_PNNo ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if&�uublic sewer is available within 200 feet) 7 Septic ank: Distance from nearest welt _ istance� from oun� ion� _7_,_.___.Materi I_,________----------------------- No. of compartments _ x_ X�__Liquid d th_�_�imance -Ca acit p j't!- ... �Ze G ?p. P y--- - -------------- Dispos Field: Distance from nearest wel�_' U)istance from foundation__�_�_________._ to nearest lot lin �� Number of lines-------- Length of each line________..___ it__....Width of trench--------Z_7.- -------------- Type of filter materi .__ __ __Depth of filter material_______-______._Total length____-_.__�_-��_Q_______-_________ Seepage Pit: Distance to nearest well----------------------Distance from foundation----------___:^___.Distance to nearest lot line____._.___-__.._ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------------------.----Depth--------------------------------_ Cesspool: Distance from nearest well________________Distance from foundation--------:__:---------Lining material-------------------------------------- F1 Size: Diameter--------------------- ----------------Depth-------------------------------------------_-_--Liquid Capacity----------------------- ---gals. Privy: Distance from nearest well ______------_-----------------------------------Distance from nearest building------------------------------------------ F1Distance to nearest lot line----------------------------------------------- --------------------------------------------------------------------------------------------- j Remodelingand/or repairing {describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ . •-------------------------------------•-- ------------------------------------------------------------------------------------•--------------_-------------------------•----------_--------------------------------------- -----------------------------------------------------------•--•------------------------------------------------------------------------------------------------------------------------------------------------------------- - I hereby certify tha4 I have prepared t is application and that the work will be done in accordance with San Joaquin County ordinances, la wand- le4'an .0regui ions of the San Joaquin Local Health District. (Signed) ----- -------------------------------------------------------------------------------------------------------(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). FOR DEPARTMENT USE ONLY yy APPLICATION ACCEPTED BY ---------------------------------------- DATE-- -----------•------- ----- --------------------------- 1:5 REVIEWED BY----------------------------- , DATE__ --------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------- ----------- ......---- ----------------------------------------•------------------------------•--•------------------------------------- -•------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ---------- --------------------------------------------------------------------------I--------------------------------------------------•--------------------------- ---------------------•---------------------------------- I ----••--------------------------------------------------------= -------- ----------------------------------------------------------------- --- --------------------------------------- -------------------------------- FINAL INSPECTION 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