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APPLICATION FOR SANITATION PERMIT Permit No. ............ . 0\ (Complete in Duplicate) Date Issued 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 Count OrdinVo. 549. JOB ADDRESS AND ATIO ..... - - ---- -----• . -- • . -- •--••-•-------•--•-----------------•--•-•---•••-------------... . --- ---•-•• - - --- --- -------------Owner's Name..... Phone__-..,_-! Address---------- .... ........... •--------------------------------------------------------•------------ ------------ Contractor's Name_______________________ -- ----- --• =-�------- - ----- ----------------------------------------------------------- Phone,,. ;`�.C�,,� Installation will serve: Residence Apartment Ho se ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑.-_ . Number of living units: -- ---- Number of bedrooms Number of baths _,1.: Lot size _ A_415� .............. ____._ _. Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adob�e* Hardpan ❑ t„ Previous Application Made: Yes ❑ New Construction: Ye�_v No ❑ TYPE OF INSTALLATION AND SPECT IF CATIQNS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta4: Distance from nearest well______ -_ Distance from foundation--------------------Material _____-714 - No. of compartments----- ------------ ---Size--------------------------------Liquith.d' e ---r --------- ---Capacity----_--------------- Disposal Fi+gld Distance from nearest we I Distance from foundation. Distance to nearest lot ling.� s Number of lines Length Length of each line........`_ ___ Width of fretxch _.___` '_. .____.__ r Type of filter material____ F.. Depth of filter-material-_ _ Total "length_______ VO ine.:.. ��_�.__Seepa a Pit: eaDistance to nearest well----- -------- -_Distance fromf dation5istacnet'6- &t%t.loxf tumber of Pits. ....:...:..._Lining materiaSize: Diameter._ _ Depth_..___ � -- 1 __.___ . Cesspool: Nstance from nearest well-----------------Distance frpm foundation Lining material.................................. ❑ Siza: Di�ameter------------ �-�- r --------Liquid Capacity ------- -----------gals Privy: Dtnce from nearest . well Distance from nearest building______. -___.... ❑ Distance to nearest lot lin --------------------------------------------------------- e _ Remodelin and/or re airi describe :_ _: -------- ----•- ---•---- ........... --•--••-----•--•- --. ......... --•• -- ----•---------------------------•-----------...............................................-------- ----------- ' - - - ------ •--•• ----------------•-------------=-------------------......... ------------------------------- - ................. ----•---------------------------------------------------------------•-•----••--------------------------------------------------------- I hereby certify that l ho prepared thig application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r es ed regulations of the San Joaquin Local Health District. (Signed)............. ------. -� ------------------------ --------------------------------------------------------------- ---(Ow d/or Contractor) By:....................---- --- ---- - -- - -- - -- - - - Title �------ -- (Plot plan, showing size of, loca ion of system in relation to wells, buildings, etc., can. be ed on re arse FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------------------------------------------------------ DATE--------- '� ' --- ------ REVIEWEDBY-----------------------------------------------------------------------------------------------------------------------•-- DAA't •---------------------------- -------------------------- BUILDING PERMIT ISSUED--------------------•-------------------------------------------•---------------------------- '*... DATE.................. . ..... Alterations and/or recommendations:.................. ............. .. ....................... ,� r --•-••....'-•.........................•----------------••-•---•---•...._--- •-"-------•-------------------------•-'-- -•------I--------•--• -•---- ........ .......... -------------------------------------------- --------------------------------•--------------_------------------------------------------------- 04 FINAL INSPECTION BY------------- Date------.Ir SAN JOAt7, U1N LOCAL HEALTH DISTRICT 130 South American Street; 300 West Oak Street 132 Sycamore Street 814 North "C'Street Stockton, California Lodi,+California Manteca, California Traey,.California ES-9-2M ; Revised W-2100 ..