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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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ZSO-I`f 0-t/ IV2JOB ADDRESS AND LOBATION_________ ____ -�--- - -- --------------- ------------------------ �✓ - --------- - Phone------------------------------------ Owner's Name_ - - --- --------------------------------------------------------------------------------------- Address--------- ---------- --- -------- -------------------------•------------------------ --- •------------------------ -- - ------- Contractor's Name---- -- --- ---• -•----•- --------------- ----------------------------- --------- ------------------ ------ Installation will serve: Resi ence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � 1_ Lot size Number of living units: __--t_ Number of bedrooms _41h--- Number of baths ___-___ V Water Supply: Public system ❑ Community system ❑ Private 4 Depth to Water Table -'0- ft. Character of soil to a depth of 3 feet: Sand ElGravel ❑ Sandy Loam ❑ Clay Loam ElClayy Adobe E] Hardpan ❑ �] Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes E] No a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fan�r'cesspool permitted if public sewer is available within 200 feet.) C Septi ank ista ca from nearest well___-�---Distance from foundation________ Material______________________________------------------ �'' compartments--------------------------Size---------------------------------Liquid depth----------------- --------Capacity----------------------- p-____-Distance to nearest lot line__-0.4---- C Disposal Field: 1 i t ce from nearest well_-__CPQ---Distance from foundation___-__ _ r of lines---------------- "--_-- -Length of each line---- �~-- -r------Width of trench----.2r ----------- C � � .Total length--------- -------------------- of filter material___^7___--1-act----Depth of filter material__- -___.___--.- 5eepag i ' Distance to nearest well------___-__-_____--Distance from foundation--------------------Distance to nearest lot line_______._________ Z ' umber of pits.---------------------Lining material-----------------------Size: Diameter-----------------------Depth------ ------------------------ Cesspoo ;/� Distance from nearest well________------_Distance from foundation--------------------El Lining material__________________.- _____-____ --_ Size: Diame_ter-------------------------------------_Depth-•------------------------------------------------- Liquid Capacity gals.. ---------- Privy: Distance from nearest well------------------------------------------___---Distance from nearest building------------------------------- ❑ Distance to nearest lot line------------------------------------ ------------------------- ------------------------------------------------------------------ Re�F,deling and/or r airin ---------- ---------- ------- " - ---- I here certify that I have prepared this appli ion and that the k will be done in accordance with San Joaquin County ordinances.4e tate-law , and rules and regulations of the San Joaquin Local Health District. -� - -------(Owner and/or Contractor (Signed) - ---4!� - -- `-- - ------------------------------------------------- ------- --- - --------------------- ------------ - 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 --- ----------------------- DATE--------------------- APPLICATION ACCEPTED BY__-______---------------- - f REVIEWED BY--------------------- ----- - - -------------- -- --- ----------------------------- _ DATE-----�----�-��--------------------------• ----- BUILDINGPERMIT ISSUED------------------------------------------------- ---- ---- -------------- ---------------- DATE------ ---------------- ----------- ---------------- -- Alterations and/or recommendations:_------------------------ - - .- -------- ----------•------------------ - - ---------------------------------------------------------------- -------- --------------------------•- -- ff FINAL INSPECTION BY----------- ---------- ------- ----------•---------------- Date------------ `P- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revisea 1-57 F.P.CO.