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�_y ✓ . APPLICATION FOR SANITATION PERMIT Permit No. err—' (Complete-'in Duplicate) Z / U Date Issued. Applicati n is hereby made to fhe San Joaquin Local Health District for a permit to construct and i sial the work herein described. This application is made in compliance wit ounty rdinance No. 549. �� k,L, (ff�,, / # JOB ADDRESS AN LOCATION..._ - --------- -------- ---------- ----- --------------------------------------- Owner's Name --------------------------------------- ---=---------------- Phone Address..--•--•----==------- .... - - - --------� ''-------------------- Contractor's Name--- ------- d -- ---r��` ---- - - - ------------------------------------------- Phone--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel}❑ Othere0 Number of living units: __.__,_ Number of bedrooms ___/__ Number of `s __/__ Lot size ----- Water Supply:,.Public system .❑ Community system I] Private Depth to Water Table__ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam�N, 0 ay Loam El Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publiVewer is available within 200 feet.) l Septic T Distance from nearest weI1540(_______Distance from foundation___ 'i ___ __. {�_ Mate i - -- --- -- No. of compartments___p�_____..___�____Size__ __ _ Liquid depth_----�-- -,�-"-=______Capacity___ --------___ ,,,,��`` Disposal F" d: Distance from nearest well-41-________Distance from foundati n/-___._.Distance to nearest lot�ne__ [✓ Number of lines______ Length of each line__ _ _____ 1d----Width of trench---_z_______�________________ �-�� T e or filter material._ ' !-_Depth of filter material__ _ _.��____Total length__------- --------------------- YP - - P 1---�----== Seepage Pit: Distance to nearest well-------------------____Distance from foundation-----_--------------Distance to nearest lot ❑ � line---------------- Number ______________ Num er o p:ts_ ______________�__- Lining materia_________- __�_ ___� _Size: Diameter------------------ ----.Depth-------------------------------- Cesspool: ------------------------------Cess ool: Distance from nearest well_________________Distance from foundation material--------------------------------- Size: ---- ---- ------------------Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals Priv 'Distance from nearest well______._________________________ Distance from nearest building g----------------------------------------- Distance ------------------------- - ❑ Distance to nearest lot line- - ----------------- -------- ---------- -------- --------------- ---------- E Remodeling and/or repairing (describe): = ------ -. -- ------- ---------------- °"s -----------------------------------------------------------------------------------------------------------------------------------------------------------=------------------------------------------------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 1 ws, a d rules and egulatigns of the San Joaquin Local Health istrict. 74' (Signed)----- (Own d/o ontrac}or) BY:--- ------------�. e� 1 /-- {Title (Piot 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- -------------------------------------------------------------------------------------------- DATES-'_ I REVIEWEDBY-------------------------------i" ---------------------- - --- ------------- ------------------------------------> DATE---!p- ----------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------- { Alterations and/or recommendations:---------------------------------------------------------------------------------------------------------- --------------------------------------- ------------------------------------------------- ____________________________________________ ______________..____________.________.._-________.___________________-______________________.__.__________________________________________________________--____________ ---------- -----------------------------------------------------.-----------: _____tib_ _____ __________ ___________ ____________ 4 FINAL INSPECTION BY:_________ -• ------------------------------ Date-----------=---�---�-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Stockton, California Lodi, California Manteca, California Tracy, California 1=S-9-2M 8-51 :Revised W-2100