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Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued __ -l--'--�-- 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 Ordinqjnce No. 549. .J JOB ADDRESS AND LO I N__._- "`-- Owner's Name----------- - f " ` �1 rt— ��- ------------ Phone Address--------a-Z.7.. .--• Contractor's Name------- _ - -- -� - _ -------------------------------- Phone----------------•----- �- "- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms Number of baths __ _ Lot size _ // -----•----------------------- / "" Water Supply: Public system ❑ Community system �Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam 0 Clay Loam lay E] Adobe [3Hardpan [3 Previous Applicatiori Made: Yes ❑ No � New Construction: Yes 9 o ❑ FHA/VA:Yes [?/'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.] �, Se tic Tank: Distance from nearest well------------- V __`'____Distance rom foundation___1p____.___.Matprial__�� _- ---------- P �° Size-4- No. deP�h �- ----Capacity------ ' No. of compartments_._- _.-___. -- '� " " Disposal Field: Distance from nearest welt _______Distance from foundation_- __ --------. Distance to nearest lot line___------- Len th of each line--------- -- "--------------Width of trench----.�"9-��---------------- Number of lines-_--- -----il g '! Total len th______- - -----------------•---- - -De th of filter material___,C ------------ g Type of filter material_/ . __ ___ ___ p Seepage Pit: Distance to nearest well.____________________Distance from foundation____.._____________.Distance to nearest lot line-__---__________ Size: Diameter----------------- Depth-- ❑ Number of pits----------------------Lining material-----------------------� Cesspool: Distance from nearest well-----------------Distance from - foundation---.-------------- ning Capacitytrial gals. 171 Size: Diameter------------------------- ------------Depth_-------------------------------------------------- Liquid ---------------------- Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building----------------------------------------- \, ❑ Distance to nearest lot line------------------------- ----- -------------------- -- --------------------- --------------------------- -----------•-----------------•------------------------ Remodeling and/or repairing (describe):---------------- --•------------------------------------------------ --------- --------------•--------------- ------------------------- 1 ------------- - - -------- ---------- - ----- ---- - ------- ------ --•--- -- - ---- - - that I have prepared this application and that the work will be done in accordance with San Joaquin County ! hereby certify ordinances, State laws, and ules and regulati ns of the San Joaquin Local Health District. 1 (fir Contractor) -- ---- -------- - 4 (Signed).. (Title) d --- -------------------------- - ---- ----------------------------------- (Tits (Plot plan, showing size of lot, location of s em in relation to wells, buildings, etc., can'be placed on reve a side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B -------------------------------------------------- DATE- NJr r _ � - REVIEWED BY--------- ---=--- -----• ----------------------------------------------------------------------------- DATE----�'--------------••------------------•--------------- BUILDING PERMIT ISSUED---•----------------------------------------------- ----------- -- DATE--------Q : Alterations and/or recommendations:------------------------------------------------------------------------------ ---------"-------•---•--------•------••-- -------------------- ------------------------------------------•------•-------------------------------------------------------------------------------------------------------------- ----------------------- ------------------------ - ------------•-- ----•-------------- FINAL INSPECTION BY:-._--------------------------- - Date--- ----- -- --- ---------------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 134 South American Street 300 West Oak Street Manteca, California Tracy, California Stockton, California Lodi, California i ES-9-2M , Revised 1.57 FY-M