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j p l APPLICATION FOR SANITATION PERMIT Permit No. ___ �} (Complete in Duplicate) Date Issued -_-____--_______________ Applicaton is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r This/application is made in compliance with County Ordinance No. 549. .IOB ADDRESS AND LOCATION_—---'--------7"_ _ Owner's Name----------------------••---•------ ' -- - --- - ------------ - ----*-l- --- - .. Phone--- .,0/—_jbn$_�'-- Address------------------------- ---------- ----------------- --------------•-•------------•---- -------------•--•------- Contractor's Name...........................£1--.ue_ .4�s •-----._ Phone---- + Installation will serve: . Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j___ Number of bedrooms 4—_ Number of baths __I--_ Lot size -------------------------- Water '.__.--_-_Water Supply: Public system 15& Community system ❑ Private ❑ Depth to Water Table 4zo ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ Previous Application Made: Yes ❑ No [M�- New Construction. Yes ❑ No ❑ -,-/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S9,1w,fic Tank:` Distance from nearest well-----------------Distance from foundation--------------------Material---------- __________- _.__._. )a�4--q No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capac_ity------------------ ------- o_ posal F•elc: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line__:_._______.___ �•-J Number of lines----------------------------------Length of each line-------------------•---------.Width of trench Type of filter mate rial..-___.________--_______Depth of filter material-----------------------Total length----------------------------- Seepage _______________________ _Seepage Pit: Distance to nearest well---- at_ -___Distance fro fou dation__r�_.__ ______ � J��' Distance to nearest loft line______.__.._ Number of pits---.----------------Lining mat eriaJO 41.Size: Diameter___- `'-__.Depth---.2j- .!> _`___________-_ Cesspool: Distance from nearest well---___________-_Distance from foundation.___----------------Lining material------------------------------._____- ❑ Size: Diameter-------------------------------------Depth-----------------------•--------- - ------- - -----Liquid Capacity-------------- -------------gals. Privy:. Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest,lot line---------------------------------------------- ---------------------------------------- --------------------------- S Remodeling and/or repairing (describe):---------------------------------------------------------------------------- ------------------------- -- --------------- ----------- -----------------------------------------------------I-------------------I-----------------------------------------I------------------------------------------------------- ------------ I hereby certify hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I , and rul,s an regulations of the San Joaquin Local Health District. (Signed) Contractor) -- r_ 0 actoBY:---------•--------------------- (Ti+le)-- �. (Plot plan, showing size of lot, location of system i la+ion to wells, but ings, etc., can be placed on reverse side): FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -v DATE REVIEWED BY ------------------- --- ----------------- -------------------------------------------------------------- DAT! BUILDING PERMIT ISSUED---------------------------------- •-----------------• ------ - -- ---- ------ DATE------------------------------- - - -- ---------------------- terations and/or recommendations:__-- ..----------------------- ----------- --------•----------------- -----------------------------•------ ----------------------- _ FINAL INSPECTION BY---------------------------------- _ / L Date - - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Scufh 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