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APPLICATION FOR SANITATION PERMIT Permit No. ._ _ � . - (Complete in Duplicate) Date IssueAl-�YS_3 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. OB ADDRESS AND LOCATION______:, Owner's Name ----- -- ----- i - Address------------------------ --- - - ------ Phone Contractor's -- Installation will serve: Residence 0 Apartment House ❑ Commercial Phone______________________ __ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _./ Number of bedrooms -`. Number of baths -------- Lot size Water Supply: Public system �{ Communitysystem ❑ Y Private ❑ Depth to Water Table _�: __ ft. Character of soil to a depth of 3 feet: Sand L] Gravel ❑ Sandy Loam ❑ Cla Loam Y 1:3Clay El ❑ Hardpan ElPrevious Application Made: Yes TYPE OF INSTALLATION AND S ECIFICAATIONS;Construction: Yes El No E] (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic Tank: Distance from nearesr well___-"-- -"_ _ i Distance from foundation__________________ Material__-"_--_- _-._ " V- Q= ' No. of compartments-.--. --- ...... .... - Size- ------ -- - - ------ ----Liquid depth - -- ---- --------- CapacitY --- -------- El ------------- Disposal Field: Qumbee from nearest well .-- ------ - - --Distance from foundation__ ______" ._Distance to nearest lot line___.___-"_- Number of lines-------------- i ----- ---------Length of each line---------- ---- -_ -------.Width of trench.-- Type or filter material___.__------ .....Depth of filter material.___"_-.-_ ----- ------ -------- Seepage Pit: Distance to nearest well__ .--'._... --Distance from foundation._ .._______.___. Distance tgohneares- lot 11 Number of pits.. ./------ -------Lining material -. --- �ize: Diameter__._.__ --"- - --------- � - Depth.-------- �------ --- esspool: Distance from nearest well._____-__.__ --- ---- ____Distance from foundation_.________________ .Lining material.._--_---- _ ❑ Size: Diameter__.--------- ------ - - --- - Depth --- - - --- ------ ---- Priv . . - - - Liquid Capacity- -------------------- - Y� Distance from nearest well_______ ____ __...... _ --gals. ❑ Distance to nearest lot line... _- ._ -Distance from nearest building--_----___ " ------- Remodeling and/or repairing Edescribe}:---_---- ---•----------------------------"---------------------- --------------------------- ------------ I hereb certify ify that I have prepared this application and that the work will be done in accordance wi+h San Joaquin Count ordinances, State,laws, and-rules and regulations of the San Joaquin Local Health District. (Signed)---- Y ------- ---- -- -- ---------- - ----------- ------------------ ------- -- ---- By:----------------------------------- --- - - Chraer a d4#m Contractor) (Plot plan, showing size of lot, location of system in relation to wllbildings, a+c., can be placed on reverse side). - - -- -----(Title)-- �-=�=-�--�-4-�--------- ---•-- • I ��F��ORDE�PARTM��ENTSF ONLY APPLICATION ACCEPTED BY..`<;4"-- - REVIEWED BY---------------- - - ---------------------------------------- DATE BUILDING PERMIT ISSUED--------------- =' ------- DATE. Alterations and/or recommendations: . DATE `�. .. ..-..-- - --- ---- - -- --------------- --- ----- ----- ------- . -- . ----------- -------------------- FINAL INSPECTION BY:- --.-- - -J.+ - ---- ------- __ __...... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore 5traet Lodi, California Manteca, California 814 North "C" street ES-9-2M i0 s2 Ravised W-2100 Tracy, California