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APPLICATION FOR SANITATION PERMIT Permit No. .�j� _`�_-.Z (Complete in Duplicate) Date /404-- 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 in compliance with County Ordinance No. 549. f�-_r" '_ JOB ADDRESS AND O TON__ 1 � ` Phone-- '/' --------- Owner's ---- Owner sm _ ----- _ Address Phone.--F------/--,o------- -- Contractor's Name ---------------- ----- -- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ + �l.-c�.G--� ------------------ Number of living units: _ �_ Number of bedrooms __Number of aths Lot size ______ _____ __ ublic.-`s stem ❑ Community system ❑ larivate Depth to Water Table _=� ffft. Water Supply: P Y Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam El' Clay Loam ❑ Clay E] Adobe 2--'Hardpan p ❑ Previous Application Made: Yes ❑, No New Construction: Yes ❑ No ❑/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk- Distance from nearest well_________________Distance from foundation___-____.___.-____..Material-___._______:__-______--------------..__________. l No. of compartments_.------------------- ---Size-------•--------------------- Liquid depth Capacity ❑ � from nearest well________________.Distance from foundation.---------------.__.Distance to nearest lot line__-______-_____- Disposal Field: Distance Q ❑ Number of.lines-----------------------------------Length of each line-----------------------------Width of trench----.--------------------- e of filter material________________________Depth of filter material--------.-------------- otal length-------------------._____--____--____.____r` _ •��__.Distance to nearest lot line__.______�-- V ------ Seepage Pit: - DiFance to nearest well.-____._�0-47----Distanc frg5r+ and tion.-__-. ___ ❑/ VA Number of pits-____.._�__._-____"Lining materia_ ___ 1� ze: -----__----�--��----.Depth_. '�---------------- Diameter Cesspool:{ Distance from nearest wel4-----------------Distance from foundation_____--._______---.Lining material------------------------ ----els. + ❑ Size: Diameter----------------------------- --------Qepth--------------------------------- ------------------ Liquid Capacity----------------------------g Distance from nearest well-------------------------------- ---------Distance from nearest building------------------------------------------ ---------- Distance -----"- - - ------------- ❑ - Distance to nearest lot lone.------------- ---- - ----- ---------------- ----------•---{ Remodeling and/or repairing (describe)_____________________ __ ___________ •------------------- --- - ----- - - --------- -------------•-------------•-------- ------------------------------------ -------- - ------- ----- ---I--------------------•-------------------------------.----------------------------•----------------•-----•------------------ -------- I hereby certify that I have prepared u his application f the San Joaquin the work cal Health be done in accordance with San Joaquin County ordinances, State laws nd rules and reg • --------------------------- !Vor Contractor (Signed)------------- - , BY� ---------------------•--------------------- -----(Tit ---- ---- -- ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY l APPLICATION.ACCEPTED BY----,\---------------- ------- - DATE----- w---- --••--.--------- REVIEWED BY---------------------------------- --------------- - -------- DAT BUILDING PERMIT ISSUED------------------------------ _ . DATE-------- - ------ Alterations and/or recommendations: ----- •----- ---- ----------- = ------------------------ --------------------------------------•----------------------------------------------------------------------------.... ....---.....------•---------•-- -----•Z--------------------•--------------------_ _____________"_p ------------------------ ______- ________._.___.._...___. FINAL INSPECTION-BY:___.:_ .___._- A Date-- •-------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteea, California Tracy, [c—o-9M Revised W-2100