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APPLICATION FOR SANITATION PERMIT Permit No. ._ (Complete in Duplicate) - 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 D LOCATION-1. !-' '---- -- ............. -�yIJAJLW.. .7.ZU�). Owner's Nam -- ----t----- -- ------- Phone j.• Address.................... -�. •---- --- --- ------•---------- Contractor's Name_ - .'___•• ----------•- ---- --------------------- ------ Phone .--•-=-• --------- -------- --------------------- Installation will serve: Residence Apartment House ❑ Commercial Ej Trailer Court ❑ Mot7l Ej Othern Number of living units: . ____ Number of bedrooms Number aths .1----Lot size t.� _ -- WaterSupply: Public system ❑ Community system ❑ Private Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam El Clay E] Adobe S+' Hardpan ❑`! Previous Application Mader Yes E] No dNew Construction: Yes Loam ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic ewer is available within,200 feet.) Septic ank: Distance from nearest wel hh, Distance fromtfou ion_-_ -U ..__..Mat �}' . No. of compartments---------Z---__-_ ---Size&. Liquid de � _ _. 1 ---- ---- - --•---Capacity--._ ��_... Dispos Field: Distance from neare:4& istance from foundation ..� ...:_ Distance to nearest lot lin -_Number of lines._ -.- ength of each Iinew�toS -�ra�2- Width of trenchType of filter materiepth of filter material --------Total length Seepage Pit: Distance to nearest well_ _______________Distance from foundation ..._..._ ...._...Distance to nearest lot line....._........... ❑ Number of pits___ ________________Lining material-----------------------Size: Diameter•___-. ..______--__..Depth---..,____ __--_----------- Cesspool: Distance from nearest well------_-------- from foundation________ --------Lining material.. _ 171 Size—Diameter`.................... Depth Privy: Distance from nearest well-------------------- __ _--__--_____Distance from nearest building., ❑ Distance to nearest lot line-------------------------------•------------------------ ------ 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 LqP9I Health District. Si ned - - - •- ----------------------------------------------------- - ( 9 ) - - ------- -------(Owner and/or Contractor) BY:---------- ------------------------------ ------------------------------ Title ---- --- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on revers-----e side)-.---- --------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._- --------- DATE-- ------- -------- ------ REVIEWED BY ............. - - ------ - ------ DATE- BUILDING PERMIT ISSUED-------•---•• ----------- -------- ----- ------------------------------.- DATE- %�''� Alterations and/or recommendations:_- .._---_ -_ - --------------------------- ---------- FINAL --------FINAL INSPECTION BY:------ -------------------------- Date.-------- SAN ---- _SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycemore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100