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APPLICATION SANITATION PERMIT Permit No _.�� 7 3 ----... �5 (Com lin Duplicate) 'J/ p Date Issued _____L__J1 App {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 Co my Onartca 549. JOB ADDRESS AND LOCATION '---- ,----•--- Owner's Name .,: ---- /' Phone...... Address.................... • r�,.,�. yy�� Contractor's Name_ . . ?.__-- Phonet'rQ_t_ .- �5 --• Installation will serve: Residence � Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ /Other ❑ Number of living units: __/___ Number of bedrooms_l!--- Number of baths ._/___ Lot size _, !_- -- _______________________ Water Supply: Public system 2--community system ❑ Private ❑ Depth-to Water Table. _. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ` Hardpan ❑ Previous Application Made: Yes ❑ No E!( New Construction: Yes R No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S�jptic Tank- Distance from nearest well________________Distance from foundation....................Material------------------------------------------------- No. ___________-_-.____. -. ._________---_____.__- No. of compartments--------------------------Size------_----------------------Liquid depth--_----------- --------Capacity--------- ------------ Disposal Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line................. �❑ �� ` Number of lines-----------------------------------Length of each line..............................Width of trench---------------------------........ Type or filter material-------------------------Depth of filter material..........-------------Total length.......................................... l4 If Seepage Pit: Distance to nearest well Distance from foundation.....�4 Distar}ce to nearest to ®fes, - Number of pits------I--------------Lining material__bu._-�ws.4 .__-__Size: Diameter---------3_.----------Depth__--_-. _-___-____� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_.-_--__________-_-______.' ❑ Size: Diameter--------------------------------------Depth----------------•--•--------------------------------Liquid Capacity------•-_---------------gals. Privy: Distance from nearest well___----------------------------------------------Distance from nearest building____-____.-_---_______________-________ ❑ Distance to nearest lot line--------------------------------------------------------- ----------------------------------------------•------------------------•---•------- r�aRemodeling and/or repairing (describe):____.. -� +- -�__________ _ Y_ _.._Y ____ __. ........ v --•-------------'-------------•----------••-----------------•---•---•-----------------•--•----•-------------------------•---------•----•-------•--•-••-----------------•-•--•-•--------•----------------------- ------ 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) Q (Owner and/or Contractor) By:---------- ( iu`` --------------------------------------------------------------................T'itle r' ,r�-a (Plot plan, showing size lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- ---- --------------------------••-•-----------•-•--•------••--- DATE-------%".�---------------------------------------------- REVIEWED BY-------------------------------- --------------------- ---------------------------------------------------------------------- DATE....... ------------- _____________________________ _______ DATE___-__.__-_____BUILDING PERMIT ISSUED____ ___ Alterations and/or recommendations___________________._____ ---------------------------- . ••••-----•- - ----•---••• ••-••---•-•••••••---•-----------•--------••-••---•--••••--••--•--•••••-------••----- •--•------•_.... - ---••--- --------------------------------------------------------------- ---------------------------------------------•-----•.._. ................ .......................................................--•-•------- FINAL INSPECTION BY:.. _. .. ...... ..... ............................... Date..----�'--........................... ----•••----•-----•------•---•--- 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 Revised W-2100