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S� APPLICATION FOR SANITATION PERMIT Permit"No. (Complete in Duplicate) ` Date Issued -": ThiApplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance ith County Ordinance No, 549, JOB ADDRESS AND LOCATION__.- _______Io2t- ------------- -- ,. Owner's Nam --------- ---------------------------------------•----------- ------ -- ---------------------- - -------------------------------------- --- Phone------------=-- Address----- -- --�---- �--�.�->�-------- � ------------------- Contractor's Name------------- _ - Installation will serve: Residence par ment Nouse Ell Commer ial Pone___________________________________ .= _ - __ urt ❑ her - �'., �: Mote! ❑ Of ❑ -�",� � .�.,, �. ❑ Trailer Number of lro�ng units: _- Number of bedjo s u ebath"! ! I_ Nu bar of s __"le_ Lot size ___ _ __D_ _ __ d_$"""" " Water Supply: Publics stem y ❑ Community system ❑ Private Depth to Water Table '_?-- ft. Character of soil to a depth of 3 feet: Sand K Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction. Yes r'�If No ❑ 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__ Q"�____Dista ce from fo ndiion__ I -Q Mat tial----- 1` - No. of compartments___-__----/S�_.___"____Size Liquid de th_ ' Capacity 4 m Disposal Field: Distance from nearest wellDistance from foundation__--_ -____-Distance to nearest lot Ii e_________________ Number of lines_____ -_ - -- Length of each line________ !V !l'----- �---�-----------Width of trench-----�-- ------------- T . e of filter ma " --------- YP 'a1- !-- -----------Depth of filter material------------I- --,-_-Total length------_--.�---�-�t------- Seepage Pit: Distance to nearest well----------------------Distance from foundation_______-___________.Distance to nearest lot line___--____________. ❑ Number of pits___ _________________Lining material-------------------------------- Size: [?iameter------------------------Depth-------------------------------- ---- ------------------------- Cesspool: Distance from nearest well_________________Distance from foundation material_______---__"--________ • I ❑ Size: Diameter___- ---._ -- -- Depth - -- ---- - ----- -- --- ---- ---- Li uid Ca acit al +r..-T�r.;.ter�r�r --------- n.,, ".�_-.�..�.�.-.��.� -� ,�. p Y als Privy: D•rstance from nearest well -' `~ ��`�'"� �"�'"'�� " ��"""��p g � ' -- ------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line__-_______- g"""" """" "" ""-----------I--------- 7j - �-y ------ ------------------------------- --------- Remodeling and/or repairing "-"------------------------------------ --------------- --------------------------- --------------------- 1 •- -- ----- - C -' �'`Z, - ------- -- ------------------------ ------------------ -------- --------- --------------------------------- -------------------------------------------------------------------------------------- ------------- ---------------------------------------------------=---- 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. ---------------------------------------------------------(Owner and/or Contractor) BY ----------------•------------'-------- -- Tale (Plot pian, 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----------,------_---__w-- DATE ---- - ---------- ------------------ I E IEWED BY -' , r� _ .-_. __:-- - ---..DATE ). �Bl}lCDTNG'PERIPIVISSSUED-'--------------�_-- --- --- -- ----- - -------- ----- DATE`--- ----- -'_-"_"- - .`� - ----- - ----- -- Aterations and/or recommendations:__�_______"_________ --------------------------- ------------ ----------------- ---------------------------- ----------------- ------------- -------------------------- -- - ------------------------------------ FINAL INSPECTION BY: Date--------- , f_�^ °?" .• ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132 Sycamore Street Sfockton, California814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100