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APPLICATION FOR SANITATION PERMIT Permit No. .. .......r....---._- (Complete in Duplicate) (}, •� Date Issuedl 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 AND LOCATION..._"___!_ ------------- ------------- -------------------•-----------------------------------------------••-•----- •----- Owner s Name - -.... Phone-----------------------•------------ Address.......�.*�----Z---4f, l-1--- ---• ------------------------------------------------•------------------------------------...- Contractor's Name--- -----1------- .c"-• -----------. Phone--��`a �__---- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ./-_- Number of bedrooms __;;� Number of baths _/___ Lot size ----------S-4_ -______________ Wafer Supply: Public system.;C 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 New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ 8 _ _Distante from foundation____IQ._/___.MateXIN ________________________ ______________ No. of com artments__ +�-' Size_ _: _ q p Capacity 9- p --------- ------------ y4_ _Li uid de th--------Vo :.------ ---Ca acit -------- - Disposal Field: Distance from nearest well-NaN6__Distance from foundation-___;Z10__' Distance to nearest lot lin e_' '--------- � Number of lines-----------�----------- ------Length of each line--------3P_-.____..__-__.Width of french--_- ��--------------------. Type or filter material__" d._ ., '__-__--Depth of teriaL___ _-_,________Total length________ a__ - ----------------------- Seepage Pit: Distance to nearest well__I_Y-WiF-----Dista ce from founcla ion___��______.Distance to nearest lot line---A470___ Number of pits....../------------Lining mater' •t"_-.Si : Diameter----- - -----------Depth------ -----_------- --_-� Cesspool: Distance from nearest well_________________Distance _ anon__- ___._.______Lining material"--_.___---_---_-_.___.___--"-_-_._ ❑ Size: Diameter------ ---------- -------- ----------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. O► Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------•--------------_----- ❑ Distance to nearest lot line------------------- ---------- ---------------------------•"---------------•------------------------------------------------ Remodeling and/or repairing (descIc ribe): ------------------------------------------------------------------------------------------------------ --------------------- -----------------------------------------------------------------•--------•------- ---•-----------------"---•------------------------------------------------------------------------••--------------------------------- 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. - Owner and/or Contractor) {signed)------------- --- ------------------- - - - ------- - -------------------------------------- - --- -- -- --------•- _ _.____ -- BY: ..... --(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 --------------------------------- REVIEWEDBY---------------- _--------- ----- --- -------------------------------- ---------------------------------------------• DATE--"--- L--------------------------------------------------- BUILDING PERMIT ISSUED - ------------------------------------------------------------------------------ -- DATE-----r ---------------------------------------- Alterations and/or recommendations:--- ` -------•-------•---------------------------------•--•--------------------------=------------------- ------ ------------------•-----.------------------------•------------------------------•- 1 �. ------------------ I Z------ ------------------------------------------------------- ------------------------------------------------ I ---I ----------------------!--------------------- FINAL INSPECTION BY:.. -------------------------------- Date"_ _ I SAN JOAQUIN LOCAL HEALTH-DISTRICT f 4 130 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 10-52 Revised W-2100