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I �tjvAPPLICATION FOR SANITATION PERMIT Permit ..-a-7-- (Complete in Duplicate) Dater issued __��a6�-•� T lication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. PP 1, This applicatiori is made in compliance with County Ordinance No. S49. ------------------------•--------------------------------- JOB ADDRESS AND LOCATION---- Pone- - ------------------------------ Owner's Name--••--- -�-------- - --- ----- Address------------------ _---------- •-•- --------------••------------------------------ Contractor's Name . - Phone �Ap ❑ Trailer- Other L]Installation will serve: Residence artment House ❑ Commercial Court Motel ❑ Number of living units: __/- Number of bedrooms __'Number of baths ---4- Lot size .-.`-__ _ ___-___-_ ------------------- � I� Water Supply: Public system �Community system El Private E] Depth to Water Table _6- ft. it Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: Yes ❑ No _New Construction: Yes ❑ No;4n;_EHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) P Size-------------------------------Liquid depth------------- -----1 of compartments = '- i - Septic Tank: istance from nearest well-________________Distance from foundation--------------------Materia____ - -"Capacity----------------------- ❑ i Disposal field: tante from nearest well._ ______- Distance from foundation--------------------Distance to nearest lot line________._______. ❑ um of lines-----------------------------------Length of each line------------------------------Width of trench Type of filter material_________________________Depth of filter material____.__________ Total length__I'._______-_______.----------------•-=-- Seepage Pit: Distance to nearest well___ ,�/�}'1,R.�D' �� "_----. '� :arEst lot Number of pits----- fining material fr m fou daze:nDiameter---_Distance to neptnr Cesspool: Distance from nearest well-___________ _.-Distance from foundation------------_------_Lining material l-------------------------------------- -Q ❑ -----------Li Liquid Capacity---------------------------gals. Size: Diameter ------------- Depth p y Distance from'rearest well---.--______._.----_ ------------Distance from nearest building-2,t_____--------------------------------- Privy: ----------- --- - ❑ Distance to nearest lot Iine------------------------------------------------ h--------------------------------------- Remodeling ------------------------------- -,---•Remodeling and/or repairing,(describe):-------------------------------------- - --------------•---'---------...------••-•--------------�----------------lk---------- ----------------------------- -----------------------------=------------------ --------------- ------------ -------------------------------------------------------------•--------------------------------------------------------------------- ----------------------- ----------------------------------- - 1 here ertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , Sta laws,,jnd �U'Ies and ulations of the San Joaquin Local Health District. V.(Signed]_ ---------------------------------------------(Owner and/or Contractor) --------- ------------------------ ------------- ------------------------------------(Title)-----------------------1-------- ------------------------------- (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 I APPLICATION ACCEPTED BY-------------------- ----------- DATE---- -------- ------- ------------- ------------------------------ BY - ------------- --------------------------------------- DATE------------� ;---------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------ - ------------------------------------------------------ - Alterations and/or recommend ---- - ----------------------•---------------•-------------------- -----•----- ations:-------------------- .. " Of lz� --------------------------------- ------------ �� ------- , - - ----------•----------- ::::::::::::::::: ----------------------------------- ---- - ----- -- - f -=---- Date---- b ' I - ------------------------ FINAL INSPECTION BY:-_------------------.�--------- - --------- - 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-9-21x1 • Revised 1.57 F.P.CO.