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APPLICATION FOR SANITATION PERMIT Permit No. .._ �- .-S (Complete in Duplicate) - d ,LL Date Issued --___1/•y�� 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 Or inance No. 549. PP JOB ADDRESS AND LOCATION----- _z" O u 7-,�r y Owner's Name ------------------------------------------------ -�------------ Phone "Q 7 Address .._ - j Contractor's Name________________________ Phone ___ ------- ___ --------------------------------- ___ ___ Installation will serve: Residence`t, Apartment House ❑ Commercial ❑ Trailer Court � E] Motel E] Other E]Number of living units: _ ___-. Number of bedrooms �_._._ Number of baths Lot size _ /Yu d Water Supply: Public system Communit system 1,16 Y Y ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe kv Hardpan ❑ Previous Application Made: Yes ❑ No.X New Construction: Yes K No ❑ TYPP 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-----�0 9 No. of compartments_._- -_ th-•.Mat ri -------------.--Size---.�X__,�,_X_-Q•_Liquid depth-__-- d� Dis os Field: Distance from nearest well_'-.--__-._- Capacity_. Distance from foundation------ Distance to nearest lot line-__._5______- Number l lines__-________ -.3_.-._ _-_- _- Len Length of each line____-_-.-_- - 2-,�ff Type of filter material g �--------------Width of trench.________._ ------- --Depth of filter material------ Y� Total length ---------- Distanceft Seepage Pit: to nearest well----------------------Distance from foundation-------------------- Distance to nearest lot line Number of pits----------------------Lining material-----------------------Size: Diameter__._-_-__--- -----------Dept h--------------------------------- Cesspool: --------------- - Distance from nearest well__-__._.__.-.__Distance from foundation_--_-_-_--__----.Lining material___----.__-___.__-__--__ _ _ _ ❑ Size: Diameter--. . .___-_ _------Depth.-._.--------------------------- -- ----- --------Liquid Capacity----------------------------gals. - nvy: Distance from nearest well.---_-..-.--_-_--._-____.______-----__-_ -.-Distance from nearest ❑ Distance to nearest lot ti 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 laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ '- :- - -•-------------------- ---------------------------------------------------------------- By;------------------------------------------------------------------------------------------------------------------------------------(Title) (Owner and/or Contractor) - ----- ---- ------- (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------.---------------------- ,;� f REVIEWED BY - -------.......... - - - DATE _ �! BUILDING PERMIT ISSUED------_,_____--..._---_--_--__ ....................................... Alterations and/or recommendstions:______________________ DATE ------------------ -------------------------------- -------------------------- FINAL INSPECTION BY---- ------------------ ---------------------- ''�� ------------------ Date-- ----------`-- ----------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street S+oek+on, California 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9 195496 A W.OD