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APPLICATION FOR SANITATION! PERMIT Permit No. (Complete in Duplicate) � L� bate Issued _/P�� 7�� Application is hereby made to the San Joaquin Local Health District for a permit to onstru t and install the work herein described. his applicafion is made in compliance with County Ordinance No 549. JOB ADDRESS AN CATIO f- - -------------------------------------- F Owner's Name----- -- -------- - - - ----------- Phone, Address__._ s ------------------------------------------------------------------------------- -•• --- - ----- --- ---------- Contractor's Name_____________ _____ Phone_ - - .. �� Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -7/4 Numberof bedrooms _ __ Number of baths Water Supply: Public system ❑ Comm -------------------- Lot size � unity system [:] Private,K Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado Hardpan ❑ Previous Application Made: Yes ❑ No New Construction.- Yes ❑ N i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s7wer is avaiiabie within 200 feet. Septic Tan : Distance from nearest welL��--_Distance from foundation____ _ _ _______Material___.________________.___________ - �xjF37x� No. of compartments--------------------------Size--------------------------------Liquid depth----------- --------------Capacity-- ----------------------- Diissposal Fiel -: Distanco from nearest well----------------Distance from foundation--------------------Distance to nearest lot line_--._________-_ Number of lines-----------------------------------Length of each line------------------------------Width of trench Type of filter material________________ Depth of filter material ____ Tota! length__-_________-___.______.-________ Seepa Pit: Distance to nearest well-._._ Distance from fou ation-- ________..Distanc�e to nearest lot line__. --- Number of pits__..__________--__Lining. material.. _ Size: Diameter_._ Depth__- !_ - Cesspool: Distance from nearest t;l______________-_Distance from foundation------------___---. rni gfmaterial..._ . ❑ Size: Diameter .. Depth ------------------------------------=Liquid CapacitY-------------------- -----gals. Privy:. Distance from nearest well-_______________________________'______._._ --Distance from nearest building ❑ Distance to nearest lot line ----------------------------- --- S. R odeling d/or repairing (describe):, ,,"----- -.? � �C� l --------- - �. • � - -- -- ------- - -- -----•------ -----•--------------------------•------------------------------------------------- --------------------------------------------------------------------------•-------------------------------------------------•------------------ ------------------------------- I hereby certify have pr ared this application and that the work wiil be done in accordance with San Joaquin; County ordinances, Std a ulations of the San Joaquin Local Health District. (Signed)----------- -------------------------------------------------- --------- ] - ------------------------------- --------------- {Owner and/ tractor By:-------- Tale------------------------------------- -----( i ] -- ---- ---- (Plot plan, sholot, location of system in relation to wells, buildings, etc., can be placed on reverse si e. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --------------- = = �, DATE �-REVIEWED BY "-- DATE , ` l ------ ----------------- --------------------------------- r - BUILDING PERMIT ISSUED------------------------------------ ----------- DATE --------------------------- ----------------------------- Alterations and/or recommendations:--..___._______._________ ._ --------------------- •--------------- -- x-�-^--� ----------------------------------------- y ---------------------------- FINALINSPECTION BY:_____.._ --- �3 ----------I ------ --- hh ---------------------------- Date fi ---- v- --------------- -- ------ - 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