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APPLICATION F OR SANITATION PERMIT Permit No. .02.4-----.-____ 3 (Complete in Duplicate) Q ` ff f ,� – �-� -- Date Issued Application is hereby de t pp y mat he San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with Covin'ty Ordinpnce 549. JOB ADDRESS ND LOCATI Owner's Name-- ------------•------------ - - -- ---------------------------------------------- --- ----------------------------------------- ph(Address---------- --- -- Contractor's Contractor's Name-- ------- -- -------•--------------•------------------------ ----- Phone ---------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motu ❑ Other ❑ - �j J /� ff 1 Number of living units: ___ ____ umber of bedrooms __16/ Number of baths __/____ Lot size �5 ------ Water Supply: Public system Community system '❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sd . Gravel E] Sandy LClay Loam E] Clay ❑ Adobe Hardpan E]E] an Previous Application Made: Yes No New Construction: Yesoam No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic ewer is available within 200 feet. 1 Septi ank: Distance from nearest well__ f/_____Distance fromkXjt1riquid nd ----l --_-_.Materi --------- No, , of compartments----------- _-.- Size__l_Q-- - dep h------------- -- Capacity-----��C - Dispos Field: Distance from nearest wel w5_0_-_ Distance from foundatiFn____1 Distance to nearest lot ine _ Number of lines----- - _ Len th of each lin p �� f1 Width of french-- ---- x.- I--------------- Type of filter materia e th of filter material_ _ _ _________Total length-------.___�-��.]___________-__---- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- L1 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- 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------------------------------------------ El Distance to nearest lot line--------- Remodelingand/or repairing (describe):------------------------------------------------------------------ ------------------------------------------------------------------------------------- ----------------------------------------------- ---------------------------------------------------------------------------------------------------------- ----- -------------------------------------------------------- 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 ,egulati ns of the San Joaquin Local Health District. [Signeef• - -----------------r -- �.. -► - ------------------------ - ------------------------ -------------------- --- - -Owner and/or Contractor) 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 --------------------------------------------------------------------------------- DAT .rte ---- --- -- - - - -------------------- ------------------------ REVIEWED BY ----- - --- --- ------------------------------------- DATE-- �-1 BUILDING PERMIT ISSUED---------------------------- - DATE - ---------------------------- Alterations and/or recommendations------------------z = ----------------------------------------------------------------- --------------------------------------------------------------------------; ----------------------------------------- --------------------•--•---------------- --- - ------------------------------------------------------ FINAL INSPECTION BY:----------- l - Date_- _ / '�•--""` 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-9-2M 8.51 Revised W-2100