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APPLICATION FOR SANITATION PERMIT Permit No. _ ._---___ (Complete in Duplicate) ,2r Date lssuede5�; 'Z�--� 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 County Ordina e No. 549. JOB ADDRESS AND CATIIQN_ '----------- ---- - ---- -------------------•---•-------------- ,''`-� r' Owner's Name ----- ------------ -- - --------------------------------------------------------------------- Phone.......�---_,�---------------- Address..... ------Address----- - ------- Contractor's Name_____________ --.. Installation will serve: Residencepartment Douse ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: ___ Number of bedrooms _,2-- Number of baths _f.___ Lot-size ___fit Qv ------ Water Supply: Public system ❑ Community system ElPrivate Depth to Water Table-F4.5- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑' Clay ❑ Adobe ` Hardpan ❑' Previous Application Made: Yes E] NoX New Construction: YeX No El '� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � r Septic Tank: Distance from nearest well_ - .29_-- Distance from founclation_,,4Gt__-_-----Materilks, No. of compartments.____ ----------------5izeX .,VV__._--Liquid d �Ca,P,6; J�5epth_ _� __'�` r r Disposal Field: Distance from nearest we4 _______Distance from foundatio _ _� --- to nearest lot line_____�____-- ]� Number a; lines--------/-r-------------------Length of each line-- ._, ¢ __.Width of trench-- ---------_--_-- r Type of filter material-------------_-----r_-__Depth of filter materi �'�_-----------Total length_ ��'_.- Seepage Pit: Distance to nearest we �j�:------_Distance rp f ndation__..,�0_______.Distance to est lot line____r_______ Number of pits----- --------------Lining materiq�---.Size: Diameter---A4— -------Dept h------��---—------------------ 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---------------------- ------------------------ ------ Remodeling and/or repairing (describe):_ __ __ _ _ ___ __ . ---------- ---- ----------------------------------------•--------------------------------------------q-----------------------------•----•------, ...------- �- -------------------------.1 --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rul and regulations of the San Joaquin Local Health District. a (Signed]------- ----- ---- '---- "------------- --- -------------------------------------------------------------- er and o ontractorj. (Own Tif Plot Ialn, showing size to+, location of system in relation to wells buildings, etc., can on neves ( P 9 Y 9 p e see). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE ---------------- - - - -------------- REVIEWED BY ------ DATE---A. ------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------ ------- A terations and/or recommendations------- ------------------------------ ---------------------------------------------------------------- --------------------------•---------•---------------------------- -----..----------- -------------------------------- -----------------•---•------------•---•-------•-----------------•--••-------•------•------------ ------------------------------------------------------------------- ------------------------------------------------------------------- ---•-----------------------•-------.•--------•----------------------------- f FINAL INSPECTION BY:.. t�------------------•--------------- Dafe. f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100