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�• � � APPLICATION FOR SANITATION PERMIT Permit Na. It (Complete 1n Duplicate) Date Issued� 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 dinance No. 549. y� JOB ADDRESS-SAND OCAT - -- --------------------------------_------ -�'"'�------------------------------------------------------�---\. Owner's Nam --- ----------"'J- -----•- ------ --------- ---------- -- ----------------- --------_..Phone.---------------------------------- Address ----•---�'� -�� '" - ----------J---------------------- Contractor's Name---- - --- - -------------------•---------------------------------------------------------------------------------------- Phone----------------------------------- Installation ---•------ ------Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Mo ❑ Other ❑ Number of living units: _ ll_ - Number of bedrooms___ Number of baths _I---- tot size __�_ _a ------�-----r______________________ Water Supply: Public system Community sysfem ❑ 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 ENew Construction: Yes [/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: J (No septic tank or cesspool permitted 'f public sewer is available within 204 feet. i, Septic ank: Distance from nearest well____1. - __ istance from founAofion__1 _-_-.______.MaterJ'� 44/_______ __ 1 No. of compartments_.____ __1wt____-____Size-&-.X_ _ �+�___Liquid depth__._______ #"_._--____._cap acity___ r�____r Dispos 'l Field: . Distance from nearest ell__ - __ _ D-stance from founda+ion-. - ✓__.___..Distance to nearest I I' �5f_..______- Q Number:ai lines__________ ,__._____._ Length of each line----------- __ ------Width of trench.______ ' 1 r Type of;filter mate _ _ - epth of filter material___.__ ----------Tota€ length_______._!__. _�__________________ Seepage Pit: Distance:to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__..______.______ ❑ Number'of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth------------------------------- Cesspool: Distance from nearest welL_______________Distance from foundation_._.----------------Lining material----------- ---.____._________._.__._- ❑ Size:-Dia_meter------------------------- ------------Depth--._------------------------------------------------Liquid Capacity----------------------------g Privy: Distance from nearest well__________________________________....____.__._Distance from nearesf building-----.----------------------------.______- ❑ Distance to nearest lot line---------------------- ---------•---------------•---------------------------------------------------------=---------------------------------- Remodelingand/or repairing (describe):----------------- -------------------------------------------------------•--------------------- --------------------- ----------------------------- -------------------------------------------------------------------------•--------------------------------------•----------------_----------------__--------.----------------------.----•--•-------------------------------- --- ------------------------------- --- -----------------------------------------------------------•-- -------------------------------------••--••--•-------------- -------------------------------- --------------- 1 hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and :rules and regulations of the San Joaquin Local Health District. (Signed).. -----------------------------------------------------------------------------------------------------(Owner and/or Contractor) B (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 AB --------------------------------------------------------- DATES----------------- REVIEWEDBY ----------------- - --------------------.------------------------------------------------------------ DATE BUILDING PERMIT ISSUED-- --------------------------------------------------------------------.- DATE---------- - ------•---------------------------------------- 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" Strae+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10=52 Revised W-2100