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APPLICATION FOR SANITATION PERMIT ,,Permit No. .../. (Complete in Duplicate `Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to sound install the work herein described. Tl-is application is made in compfanc® with County Ordinance No. 549.' dfl , JOB ADDRESS AND LOCATION_.; _.... __ _..__ ... ..LOCATION_.; .. ..........'__ ..7._7......____._.. --.l. . ......................... „ t Owner's Name--- ----- P '- .: .:.... ----�ri ---- Address Contractor's Name.: .......... ---------- ----- - Phone Installation will serve: Residence 4g Apartment House❑ Commercial ❑ Trailer Court t ;Motel ❑ .Other ❑ - Number of living units. -:---- Number of bedrooms __3__ Number of:baths _A.. Lot size L_kr4....__. __ .w.................... Water Supply: PubYt system ❑ Community system n Private tYsapth to Water Table$'P_ ft. Character of'soil to a depfli-af 3 feet:`Sand ❑- Gravel❑ Sandy Loam Za Clay Loam ❑ Clo13 Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑,- No N 'New Construction: Yes"o NoFj TYPE OF INSTALLATION rD 5PECIFICATIONS: (No septic tank or cespool.permitted if public sewer is available within 200 feat.) Septic Tank: Di+stance from neareest we{I `Dis ", "Pram-foundation-�____t M I _---.. No. of compartments.—al ________Snze_ F. ':_ _--,.Liquid.depth-_:--�r Capacityl.�G.P_____---- Disposal Field: Distance from nearest wel{ B ......Distance from foundation.-Ay.. Distance to nearest lot lune r1* ] Number of lines__ --- , _.. _____ Length of each line___ iQ'' Width:of trench '" ____ Type of filter materia �I Depth caf fitter m$ er! 1 Total length �j�Q'- -- ............... Seepage Pit- Distance to nearest)we __Disfancernfrom foundation......::. ........Distance to nearest lot ne................. Number of-,pits ---Linin material......................Size: Diameter--_-- -_._•___.___.De h.._.____ ..................... Cesspool: Distance' from nearest wt� Distance from foundation Lining material._ ____. [] Size: Diameter "' {r,>- DeP�h _- •--- ------- Liquid Capacity .. - gals. Privy: Distance`from nearest well_.------ -__--- ------------- ------'Distance from,purest buiilding..............................__.__ El Distance to near st lot.line r- Remodeling and/or repairing describe : _. •---- ----•------- ....: -- g / p g .:.. P ... ..____ ____________ __ _____ ___.-_......... S�..............i............. ........................... ...,_............................................,............................................ ................_--------_-------------...................... ,------.........._____,_------------.................................................................................................................. I hereby certify that I have prepared this°.application and that the work will be done in accordance with San Joaquin,County ordinances, Steffe laws, and rules ,4 regulations of the-;San Joaquin Local Health District. (Signed)___- B (Owner. and/or Contractor) By: -. __ _ .._ _ .. ... .. _ .._. .(Titlel . ._ ..................................... (Plot plan,showing sirs of1ot, locate of system in relation to wells, buildings, etc., can04 11ced,.on si }. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ ___________ _____ ___ _._.,_._---. .............. DATE_-h.','�._.?,z__`_4 P--_ REVIEWEDBY............................................................................................. .... ........................ DATE.,.--- •-•-- -- •-- ---•- BUILDINGISSUED----•--......... -••-------- - ---- – --------_..... ,.....:. DATE. .--•.................. _:..-•. `..:,. :...._.....----- Alterations and/or.recommendations:..................... .................. ......:............ .........................,.., -- _...:• -••-••.............. FINAL INSPECTION BY ' •�_ . _. ...................... Date__ ------ .............................. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Str**t4, 300 Wast Oak Street 132 Sycamore Street 814 North "C"Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M i Revised W-21-00