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APPLICATION FOR SANITATION PERMIT Permit No. 1 (Complete in Duplicate) Date IssuedVi -6._-�s' Appiication 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. JOB ADDRESS AND LOCATION....------ 5---- ' •----------------------------------------------------------------------------- Owner s Name-]------------------------ ----- ---------------------- Phone----------------------------------- Address --• . 4 ------------------••---------------....._ Contractor's Name.----------•a---- ------ Phone---------•------------------------- Installation will serve- Residence KI Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms 3_ __ Number of baths .------- Lot size ___ S_.____X___ _________________ 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 ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation__--________-______.Material-------------------------------------------------(, ❑ No.:of compartments------------- ------------Size--------------------------------Liquid depth------------------------- apathy----------------------- Disposal Field: Distance from nearest well-.----.----------Distance from foundation--------------------Distance to nearest lot line______________-. v1 ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- 1 -' Type or filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ W Seepage Pit: Distance to nearest well._--------------------Distance from foundation--------------------D]stance to nearest lot line___-.-______-_-._ ❑ - Number of pits----------------------Lining material---------•-------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well_,C#W Distance from foundation-__. D____ Lining,materia(___/rg4Wtda_----_____ ® Size: Diameter__ x_'S__ _tY-------------Depth_--------------- ----------------------------------Liquid Capacity-----/2l1_d-------gals. i Privy: Distance from nearest well-_- -__ *= ?�----------Distance from nearest building5_�`-__-------___________-_._. Distance to nearest lot line--------- -- ---- -- ------------ --- Remodeling and/or repairing (describe):____ . - -- -- ------- - ---- - ------ ----- -------- -----•----- --------------- ------------------- ---------------------------- -- ----------- ---------------------------------•--------------------------------------- ---- ----- - ----------------•----------•----------------------------------------- ---------------------•--------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signe •'�_f_f .- , ------------------------- ---------------------- -- - -----------------------------------------------------------------(Owner and/or Contractor) -- -------- Tale - ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORD ARTMENT USE LY APPLICATION ACCEPTED BY----- DATE--------- ---------------- REVIEWEDBY----- ---------------------------------------•----------------------------------- ----------------------- DATE - -- -------- BUILDINGPERMIT ISSUED-----------------------•----•----------------------------------------------------------------------- DATE----------------------1_---6 Alterations and/or recommendations------------------------------------------------ ---•-•---------------------------------•----------•--�--- ,:" `�� _....-------- !rte ----------•-------•------------------------ ------------- -------------------------------------------------------------- -------- ------------------------------------------------------------ -- ------------------------------------- -------------------------------- ----------•-------------------'---------------------------------------•------------------- --------------------------------------- ------------------------------------------------------------------ f Date------- -- -- ---------------------------- ) FINAL INSPECTION BY:..----- - �" = 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