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r APPLICATION FOR SANITATION PERMIT Permit No. (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 C/o�unt�yj Ordinances No. '549. � f JOB ADDRESS AND LOCATION-------3_'T..._L_---------_----J-- ----------KU---�__11._- - - -- Owner's Name ----------------------------- --------- -- Phone---------------- ------------------- Address-.----4-A-_ :...-- Contractor's - ------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --_I--- Number of bedrooms ____ Number of baths .___l__ Lot size --------57k• 1. ___________________.______ Water Supply: Public system IM 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 jZ Hardpan ❑ Previous Application Made: Yes ❑ No [XL New Construction: Yes ❑ No [7� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Ta�n :�js. nce from nearest well----____--_._--Distance from foundation__-_____-_--.___-.Material-______----------------------------------------- . ❑ of compartments--------------------------Size--------------------------------Liquid depth------------------------.-Capacity------------- -------- Disposal Field: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line----------------- ❑ �' �iiber of lines-----------------------------------Length of each line-----------------.----------.-.Width of trench------------------------------- ype of filter material--------------------- ---Depfh of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well__/✓uNL__pistance from fo ndation---_ _v----.......Distance to nearest lot line..___`s.______ of pits._-.--_L...._--.-.-Lining material-_- - ---�-� -- Size: Diameter--_-_ -.__Depth.._ ----------------------- Number Cesspool: Distance from nearest well----------------_Distance from foundation______---___------- Lining material------------------------------------- 4) ❑ 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):_-------------------------------------------------------------------------------------------------------------•-------------------------••-------•---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------•------.•-------•-----------•--------------- -------------------- ------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat a s, and rules and regulations of the'San Joaquin Local Health District. (Signed)------ ---------------------------------------- ----- ----(Owner and/or Contractor) --------------------------------------(Title)------- = (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_------ ---- -- -- - --- ---------- ---------------------------- DATE- � ----------- -- -- - -- ------------------------------- REVIEWED BY -- -------- ---- DATE BUILDING PERMIT ISSUED-------------------------------- ------------ - DATE----------- ---- --- Alterations and/or recommendations---------------------- ------ --------------------------------------- ---•---------------------------•---------------------------------------------- ---------- -- --------- ------ -------------------------------------------------- ----------------•- ------ - ------------------- ------------------- ------------------------------------------------------------------------------------------------------ ------------------------------- ---••----------------------....--•-------- FINAL INSPECTION BY:_. ----------------------------- Date-------- -------+----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerie'an Sfreef 300 West Oak Street 132 Sycamore Street 614 North "C" Street Sfockton; California Lodi, California Manteca, California Tracy, California ES-9-2M 1454"ATWOOD 12-9a