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APPLICADON-. zOR SANITATION PERMIT �Permit No.,-��._�``_�� (Complete in Duplicate) Date IssuedlP_�----,�._+�� 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 co lance with County Ordinance No. 49. S,:� � y� JOB ADDRESS ANDLOCATION- - ---- -- -- ---W--- .....-i- ---•----`------------------------------- ---------------••------•-•--------•--- Owner's Name........ -'4t - - ---•----------- --------------------------------------------- --- rn ne------�•=14-. --)- Address------------ `t------- tt,, Contractor's Name------.Cy!- ..?------------------------------------------------------------------------........................... Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I____ Number of bedrooms __I____ Number of baths _....... Lot size .......lo_4---y...1_w!_4!________________________ Water Supply: Public system ❑ Community system ❑ Private g Depth to Water Table. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well (�_-__Distance from foundation__.140.........Mat rial__ No. of compartments__-____ :2--------- __Size_�9--r_._D...............Liquid depth_ (____________Capac ttoi Disposal Field: Distance from nearest well_._.rS- _a---Distance from foundation______/0--------- to nearest lot line._ ......... Number of lines....._------/--------------------Length of each line....J,�"D.............Width of trench.,a_�_ .-„�______________ Type of filter material-------------------------Depth of filter material-----------------------Total length_________l__Z. ------------------ Seepage Pit: Distance to nearest well_____________________Distance from foundation....................Distance to nearest lot line......_.......... ❑ Number of pits______________________Lining material____ ___.__.___.._-_Size: Diameter-----------------------Depth _________________-__________ G Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_ ______________-__._____.___ p `Il ❑ Size: Diameter--------------------------------- ----Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---------------------------------------------_...Distance from nearest,building-----------____._________________________- N ❑ Distance to nearest tot line----------------------------------------------------- ,..........................................................................-------------- _\ Remodeling and/or repairing (describe): , ,,4, _____________________........................ -----•-•--•---•------•---••-•-••--•------------------------•----••----•----••-•-••----•----•---•----------•-----------•--•----------•----•-------•----••-•-----------•--•-------------•----•---------•------•---------------- -•-----_..---•-----------•-------•-•-------------------------------------------------------------------•---------------------------------------•--•------------------••-•------------•-••----------•-----•--------•----•----_ ----•------------------------•-------------------------------------------------------•-•------------------•-----------------------------------•---•--• --------........................................................ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, d rules "regulons of the San Joaquin Local Health District. (Signed)-------•--•---•---.. -- - - -------------------- ----------------------------_-----------------------------------(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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - DATE-----'y�------•---------------------------- ------ REVIEWEDBY--------------------------------------- -------- - DATE-------------` ` BUILDING PERMIT ISSUED - DATE -............................ Alterations and/or recommendations:---•------•-• -----------•----tj-----•--•-------•-------------------•--------•-••------------•-----------------_ •-•---�-----.._....--------•-- --------------•------------•----------------------------------•----•-------------------------------------.--. ------------------------------------------------------------------------•-•----••--••--...--------•---•-•_•••--- ----------------------------------------------------------------------------------------------------------------------------------- ---------------------------•-----------------------------------------------------••--- ............................................................ ----------------------------------------------------------------------------------------•---------------------------------•..---------------------••-------------- -------------------------------------------------------------•----•--•-----------•--....__.-....--••-----••-••--•--------•-•----••-•---•••---••----•-•----•---------------•--•-...--•----- •--------------- FINAL INSPECTION B ... = -------------------------- 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 Revised W-2100