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APPLICATION FOR SANITATION PERMIT Permit No.. ._-_:.��. -' .•-��' 4111 (Complete in Duplicate) y , A Ip I Date Issued __L ___7�5•--�� , cation is hereby made to the San Joaquin Local Health District foraermit to constru This application is made in compliance with Court rdin nce No. 549. p ct and install the work herein described. JOB ADDRESS A LOCATION___.__ _ ---4------- --------------------------- ---------------------- Owner's Name--- -- -- - ------------- - -------- ------------------- ----------------. Phone--------------------- Address---=�. --•••---• -•• -'-•--•.. Contractor's Name__ _____ ______ Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ ❑ Motel ❑ Other ❑ Number of living units: _V,oummunity mber of bedrooms -&-• Number of baths __L.__ Lot size ----------------------- Water Supply: Public system system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan E]Previous Application Mahe: Yes ❑ No 7New Construction: Yes [ o ❑ TYPE OF INSTALLATION.AND SPECIFICATIONS: (No septic tank or cesspool permitted 'f public sewer is available within 200 feeto - Septic ank: Distance from nearest well - . .- ista cie fr fou? �ion_j. ater I - v -- No. of compartments__-__ - --- ize�_.111_ -_____ .___Liquid id th-__ ,,,�P��---- -------A��apac,-�y... - - ------ - - Dispos Field: Distance from nearest wel Distance from founda#ion�� istance to nearest loill e - - Number of lines__________ _______ _ _ ____ Length of each line-------____.�_�© ��-Width of trench___-___� _ _______ Type of filter mater _ _ -_r _ pth of filter material___________- __ .`. -Total length----•.------•.� ----------------- -\ Seepage Pit: Distance to nearest,ApII______ ______________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: Distantce 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, Sfa laws, arld rules and r ulations o heSan Joaquin Local Health District. (Signed). ________________(Owner and/or Contractor)_ By: -••--•--•-------•-•---•----••----•--•-•---•--------•---- ------ ---------------------------------------Tale (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 APPLICATION ACCEPTED BY__ DATE -r REVIEWED BY-------------------------------- DATE__ "t ,- -- BUILDING PERMIT ISSUED.___ - ------ __- _ .---------- DATE--- -- Alterations and/or recommendations:------_------------------___.......................................................... ------------------------------------------------------------------------- I ---------------- ----------------------------------•-•------- -------------------•--------------------------------------------------------------- --------- FINAL INSPECTION BY:- - `------------------- -- ----- Date----- t F 105 /---------------------- ----------------------------- 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