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APPLICATION FOR SANITATION PERMIT Permit No. _ . t� (Complete in Duplicate) *0�Y4� Date Issued --_- 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. JOB ADDRESS AND LOCATION.-div --------------- Owner's Name---- -- -_..--•••'-•------- ----- -- -- -------- ------------------------------------------- Phone................................... Address-----------. ----- •---•-•----•--•-- . . 2---5........... --------------- -•--------------------------------------------------•---- Contractor's Name---...... --- -- -- -- ------------� ---------------------------------------------- Phone,,—e-_-_�T' �Q•� Installation will serve: Residence [ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/---_- Number of bedrooms �-Number of baths ./-_--_ Lot size -_- ---------------------- Water Supply: Public system ommunity system ❑ Private)(I Depth to Water Table Character of soil to a depth o 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L�_ Hardpan ❑ Previous Application Made: Yes ❑ No g_.New Construction: Yes D3-_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s Septic Tank: Distance from nearest well.... Distance from foundation_____ 1-r.Material....�� C� _�.___.._._��:' -___---_-. No. of compartments---.,,;2------------ ?C__„�l�Li uid depth______&.Q_____-_--_Ca acit T 'd_-_--__- Disposal Field: Distance from nearest well----.1a✓r.---._Distance from foundation---- __-----Distance to nearest lot line...l4�__----• QL Number of lines--------1,/.__X:_ Length of each line........ of trench........ .__--____--_-_- Type of filter material.7.b________�,�'�'_-Depth of filter material ----.--/8-------Total length----- ....................... Seepage Pit: Distance to nearest well_.1.07-__ _-_.Distance from foundation.....3e.._'-__.Distanceryto nearest lot �_. Z Number of pits------f-------------Lining material.... �_`� �e: Diameter.....3---3------._Depth--_2., -/--- ------ Cesspool: Distance from nearest well__--_•.--:---___Distance from foundation--------------------Lining material-------------------------------------- El • _.__-_-.•____-_---_-_--._-----.❑ 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 d rules and regulations of the San Joaquin Local Health District. (Signed.- - ------ - .,--/ ------c (Omer 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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- 1, DATE----------- REVIEWEDBY---------------------------------------------------- ------ --- ---------------------- ------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED-------•------------------------------- ------------------------ ....... DATE------------------------------------------................. Alterations and/or recommendations: --- . - ----------- r ------------- --------•--•----•----------............................... ------------------•-----------.....-------------------- - ------------- -- - -------- '} -------•--•-------------......--•------••-......----.••---- t.�--- � ------------ --- ----- - -- - a..� . - --- ------- ..................................................... . ............. .............•-- ----------------------------- ---------------- - 5- FINAL INSPECTION BY:.------ Date -=S- 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 Revised W-2100