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APPLICATION FOR SANITATION PERMIT Permit No. f . (Complete in Duplicate) y- r'')" Date Issued ____.{__�9.3_,� 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. ,/� 4.�,L� JOB ADDRESS AND LOCATIO - ---- D ...... . ..2 � - --e----------?--.,z-f ........................................------------------- : .. Name 19,G1..� ... -5 ------------------------------_ Phone---------------- -----------------=- Address -?/.......................................... Contractor's Name----------------------------------------------------------------------------------------------------------------- -----..---------------- Phone................................... Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �' Number of living units: ---/-- Number of bedrooms __ -_ Number of baths ._l___ Lot size ____.>._Q_ __ye..../_ ___ _____________ Water Supply: Public system IX Community system ❑ Private ❑ Depth to Water Table -------- ft. 4: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 14 Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Nr 0-K Septic Tank: Distance from nearest well---^ Distan Jro Ifo n�n----/,0--------Mate 11------ D-d: --'''_ Size_t No. of compartments_--_-_A-____ _, -----_Liquid depth ----------------Capacity---��"i�-___ Disposal Field: Distance from nearest well____ ---- Distance from foundatio 1.Q_�.. t (stance to nearest lot ine----- Number of lines________ _______ ______ ____Length of each line_g0�_ _ �dWidth of trench_-_A_T_ � Type of filter material.-57IG� `' Depth of filter material . - Total length-------��Q-------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-------._--__---_ ❑ Number of pits----------------------Lining material-------------------__-Size: Diameter------_•_•----.__.-----Depth--------------------------------- 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-------------------------------------------------------------------------------------------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. (Si ned 9 )----- - ------ � � (Owner and/or Contractor) By:-----------------------------------------------------------------------------------------------------------------------------------(Title)---------- ----------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FO P ENT USE ONLY APPLICATION ACCEPTED BY------------ z f ------------------------------------------ DATE......... - REVIEWEDBY ------------------------------------------------------------------------------------------- ------ DATE-------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----------------------------------------------- Alterations and/or recommendations:----------------- � •-------- --------- --------------- -------y�-------- ----------------------- --------------------- - - 'e- 1 - --- �- !� - .---------- ---------- -- ----- ------1tx_* _-----L �; � °L"- -- ---------------------------- -- - -e .-- - ---- ------ - - = - ' lQ----- 4-----a �----- ll:__ r-_----/ --..- ;, - -- ------------ - ----------- ------------ 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-9-2M 10-52 Revised W-2100