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APPLICATION FOR SANITATION PERMIT Permit No. :. a.��...__.- �, (Complete in Duplicate) �0� Date Issued Applica*ion 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 incompliance with County qOrdinance No. 549. JOB ADDRESS A z CATION---------cf'_ `----- ----------- -- Owner's Name o --•----- ` - - Phone - Address__._ Contractor's Name----- ----- -------------------------------------------------- Phone-------------- ----- ........ lnstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ //Motel ❑ Other F]Number of living units: __/__ Number of bedrooms Number of baths ---/__ Lot size ------- �� A _ •------•---------.. Water Supply: Public system 54—Community system ❑ Private ❑ Depth to Water Table f6lJ ft. Character of soil to a depth. of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R_ Hardpan ❑ Previous Application Made: Yes ❑ No's_--New Construction: Yes,gL No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septictank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: ! lstan from nearest well------------------Distance from foundation---------------------Material_.------_---.-----.-..__-______----.-..-_-.-:.__. Jo. compartments..........................Size---------------------------------Liquid depth--------------------- - --Capacity Disposal Field;, D' tante from nearest well-----------------Distance from foundation-------------'......Distance to nearest lot line----------------- r r of lines------------------------------ ---Length of each line----------------,------..------Width of trench.-----------------. Typ f filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well____ d Distance from foundation--_.4.0- -- Distance to nearest lot line..__ .� IQ ` p ___.Lining material_L� �� Diameter:.. .4 if De to--__ Number of its_,_.__ ___._ _ P ' dIP24.5- - Cesspool: .. Distance from nearest well------------ --Distance from fou.ndation __Lining material._.__-----..-----.-..-...._--_-------. ❑ Size: Diameter--=--------------------------------- Depth-----------------'----------------------------------Liquid Capacity------ gals. Privy: Disfance from nearest.well_..____----_____________.___--___._,_____.:Distance from-.nearest building------------------------- "- ----------- ❑.. -Distance to nearest lot line------------------------- -----------------------A- � '- -` - Remodeling and/or repairing {describe}--------------------------------------- ------------------------------------------------------------------------------•--•-------•---------------••-- ' ------------•---------•----------------------•-------------•---- -------•--------• ------------------------ ------------------1----------------------------------------------------- -----------1----------------------------- •-------- ----------•-.--------•-------•-------------------------------•----------•-----------.....------------------------•--------------------=---••-------------------------- �' I hereby certify t prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and r s and regulations of the San Joaquin Local Health District. 7 CZ igne )--•'--- - .. ------ lx - ---- -----------•- ,. ----- ----•----,----------------------(Owner and/or Contractor) r � By:------- -- -- ------- ---- -- ---------(Title)----- - -'------------------------------ (Plot plan, s owing size of lot, location of system in relation to we11s, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ------------------------------------------------- DATE-----�------------------------------------------------- REVIEWEDBY----------------------------------------------------------- - ----------------------------------- DATE t BUILDING PERMIT ISSUED DATE ;---------------------------•-------- Alterations and/or recommendations:_ -------------------->.._- _---\1---...._-.-..---_-.-----_-._---_-. - C ------------------•--.. . ----- - - l ---•--------- ------------------------------------------- -------------------------- - ---------------------- ----------_ ----------------------------------.------------------------------------------ .._...__----.-----__-__---___-_--- FINAL INSPECTION BY:._ Date . . 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 W9 145446 ATWptlD