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s t - APPLICATION FOR SANITATION PERMIT Permit No. /o ._ (Complete in Duplicate) 1 O - �/ Date Issued • ____��"_�_✓` Application 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 Ordinance No. 549. JOB ADDRESS AND LOCATION ----`--�x--- = '�< .......... - Owner's Name----------------------------------- - -- ------- --- Phone Address_ ------- -------------- --- - ' ^� f 60 Contractor's Name-------------------------- -- -, _ -� C? f/--_----_ Phone.--9'_�-__--___ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1.._ Number of bedrooms .%--Number of baths _1____ Lot size _____6-&--,*... ------______•- Water Supply: Public system ❑ Community system ❑ Private je Depth to Water Table lr-oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe,ff Hardpan Previous Application Made: Yes ❑ No New Construction: Yes �" No E]TYPE OF INSTALLATION AND SPECIFICATIONS: ✓✓' (No septic tank or cesspool permitted if, p eic sewer is available within 200 feet.) Septic Tank: Distance from nearest w II +��__Dista�nc+e from foundation. ...........MateriaL_�e/4�'��, "'+ � w._ No. of compartments.. ________--------Sizee:�. Arom;oundation__/ _.__---Liquid depth...+ ir"______ _Capacity;. Disposal Field: Distance from nearest well SGS ..Distance Distance to nearest lot line a1 ON Number of'lines...... _____ rr___ ____Length of each line ! Width of trench_ �� Type of filter material_..�lf.-_t to___Depth of filter material____/8!!_.__•Total length____._�Q__•. ................. r ` Seepage Pit: Distance to nearest well!________-Distanc fr foundation....Ea--------Distance to nearest lot Ime Number of pits_- --------------Lining material gl ----Size: Diameter___.,;[.,,q_'fj......Depth-_O J ---- Cesspool• Distance from nearest well_________________Distance from foundation _________ _--__.Lining material-__ ❑ P -----Liquid Capacity ----...................gals. Size: Diameter----• -----------------------------De th------- ------------------------------ Privy: Distance from nearest well _________ ------------------------------------Distance from nearest building-------------------------------______-_.Distance to nearest lot line-------- ---------------------- ------- ---------- ----- ---- -- ---- - ----------------------------------- Remodeling - -----• -----.----------=Remodeling and/or repairing (describe):------------------------------------------•------------------------------------------------ -•-.---_ -....---•--•. •-----•---•--• . ----•-• •-----• ------- -------- ------ -------------------- -- -•--- -••-- •------ --------------------------------- ----- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, les and regulations of the San Joa in Local Health District. (Signed) t - -------- --- ww c mractor) x --- By:- -------------- ----- ------ ----- -- -----(Title) ---------------- (Plot plan, wing size of lot, location of s stem in relation to wells, buildings, etc., can be p ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- --- ----- ----- --- ----- ------- --------- ------ DATE�--------------------------------------------- REVIEWED ----- -------- =------- -------- REVIEWED BY - - ------ - ----- -- --- --- DATE_._ ----- BUILDING PERMIT ISSUED----_---------- DATE Alterations and/or recommendations- ----- -- ------ ------------------------------------------- ---------•- - --_ ----------------- ---------- ----------------------------------------- ---- - ----- ---------------------------•- ------------------ --- - FINAL INSPECTION BY:---- Date-------- -17--o-<; --------------------------- --------- ---- --------- ------ a- 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 8-51 Revised W-2100 t