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APPLICATION FOR SANITATION PERMIT Permit No. •.5-�,3-5-__ -- A (Complete in Duplicate) Date issued Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install fewhor he ein desc bed, + This application is made in compliance ount Ordinance o. 549. r ss3� JOB ADDRESS LOCATION.---- a Owner's N ----------- ---- --------- --- -------- ------- Address--- �• .......... Contractor's --- •--• - -- _. --- ; -.- Phone-- - ----- - -- -- ---- Contractor's Name_-.----•-------•-- - -----•--••--•---•------- •---------- p - ----------------------- nstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: _/-- Number of bedrooms f vv❑ Other ❑ . --- Number of baths ---f-- Lot;size 74— /�---------Water Supply: Public system ------- " ------- - PR Y� - ------ --- Y ❑ Community system ❑ Private A Depth to Water Table6-6-- ff. Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ 5andy Loam ❑/Clay Loam ❑ Clay,❑ Adobe ElHardpan E]Previous Application Made: Yes ❑ No New Construction: Yes [ii-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 � Dista ce fro foundation-- _ -� �1- Materi I ----------------------•- �'' No. of compartments-._"--__- " _- -_".-_Size _ Y1-6------Liquid"depth.------"--- Disposal Field: Distance from nearest well -6-, Capacity-_--_ --- istance from foundation----14 -_- -"---Distance to nearest lot line---r Number of lines-_----"--- ---------- --- --------Length of each fine_----- - ¢0 Type of filter mafieriaL �_ Width of trench Depth of filter material--_-- - � - ---------Total length.--------/-r 'Q---- _ _________ Seepage Pit: Distance to nearest well------------------"---Distance from foundation-------------------.Distance to nearest lot line---- Number of Pits----_.- ------------Lining material-----------------------Size: Diameter Distance from nearest well-----------------Distance from foundation El mateDaptn------------------ --- ❑ Size: Diameter I Depth_.- ='- --- -- ------Liquid Capacity- --------- ---------gals. Privy: Distance from nearest well_ ....... -f -- Distance -from nearest buildin ❑ Distance to nearest lot lin`e.--- _ _ g ---------------------------------1 --------------------------- Remodeling and/or repairing (describe-----------------"--------------- - -------------- ------------- -----•----- ------•--------------------•----------------------------------•----------------------------------------•-------------------------------------------------------------------------------- ------- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, SfM laws, and rules and ulationsthe San Joaquin Local Health District. (Signed)_--- - By:. ----- - -------------------------------- ------_(Owner and/or Contractor) .. - ------------- ------ ••--- (Plot plan, showing l ----- •-------- --- ---------------------- ----------------(Title)--------------------------------- - s-ize of lot, ocation of system in relation to wells, buildings, etc., can be placed on reverse_ side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---•-- -- --� --- ------------ •---------------------------- DATE---- REVIEWED BY--. -------- -------------- - ----------------------------------------------------------- DATE BUILDING PERMIT ISSUED_ ------- - = -------------------------------- _ --- ----- ----- Alterations and/or recommendations:-"-.- t �f� C *DATE _,--_ --•-- - •----------"-------------------- ---------------------------------------------------------- FINAL INSPECTION BY:. ....................................... ....... Date-_�/-"�-..�_. -- ---- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT !30 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M 10-52 Revised W-2100 J f