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14 Ido APPLICATION FOR SANITATION PERMIT Permit No. ...___..__.._.._. {Complete in Duplicate} (p Date Issued 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 Ordinance No. 549. JOB ADDRESS AND LOCATION--------- - ----- -- Owner's Name /i :._,..� ' --------------------- ---- - --- -"-- one.. Address ---- -------------------------------•--------------- ---------------------------------------- Contractor s Name - will serve: Residence Apartment --------------- --------------- InstallationPhone_- - partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units: Number of bedrooms -------- Number of baths -------- Lot size -_--_'_rl - ' Water Supply: Public system X Community system El Private E] Depth to Wafer Table' ' - ._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan I] Previous Application Made: Yes ❑ No R- New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ' -Tank: Distance from nearest well__--------------Distance from foundation..-_.- - --- Material.-. --- --- -- - - - - ! No. of compartments- - -- ------- - -----Size Liquid de th - (= Di b r p. - ---Capacity----- --- -- -- Dis al Field: Number of°I nes----rest we,l__.----_ - -. Distance from foundation:--- .._._._.------Disfance to nearest lot line-------- ....._.. -- ----------Length of each line---------- -----.-Width of trench-------- ------ Type or filter material------------------------Depth of filter material- --- -------Total length--------------------------------- ---__ --- Seepae Pit: Distance to nearest well---�^/tik_;-------Distance from foundation---- Distance to nearest lot line.___/..' umber of pits.- -- Lining material .4 _. Size: Diamefer_.,j ` --___- De tn------ - - ----- esspool: D"stance from nearest well------_----------Distance from foundation.._._..____- ----_ Lining material-....- --- - -- - ❑ Size: Diameter--- -- --- --- --- -- - - Depth - -- -- - - Liquid Capacity - --- --- - -- - gals. rivy: Distance from nearest well----------- ----- ----_Distance from nearest buildin Distance to nearest lot Fine.___ -------- ---- -------- --- Remodeling and/or repairing (describe':_.-_---- -- ------------ -------------------------- --------------------------------------------------------------------------------------- ---------- --------------------------------------------- - --------- - ------- - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regullfions of the San Joaquin Local Health District. (Signed)g } - .............. {Owner°ari2�/or Contractor ' - -- - ------ --- -• } By: ------- --------------------- -- --- ---- -(Title)- -------I-- ----------------------- -- -- - ------- - ---- - (Plot plan, showing size of lot, location of system in relafi to Ils, buildin s, g ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------ - ---- - DATE - VIEWED BY --- ---- -------- ----- �- - -, - - -.... ............. ---- --------------------- ---- _ DATE_-.'- ----- ----------- -- UILDING PERMIT ISSUED.-------- �-------= ------- ---- ----- --- ---- -- .. --------•-------------------------------- - ----- DATE--- Alterafions and/or recommendations:-_._-__-._._ -- ------- ---- ----- 5 FINAL INSPECTION BY__________ ___ ---- -- ------ !J -- - -- date- -- ... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" $}reet Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M o-.`2 Revised W-2100