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APPLICATION FOR SANITATION PERMIT Permit No. � -• -'--- --- �� li (Complete in Duplicate) �1 l Date Issued __--_ r_- _-'�-- Tglica+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 County Ordinance No. 549. JOB ADDRESS AND LO ATI N /_. ... ...--------------••--------------------------------------•---- Owner's Name__..- ------------•--- ----- -- Phone------------------------------------ Address...----- -------------- Contractor's Name.---- - •-•-------•-- Phone __ 1r/�- i Installation will serve: ' Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _Number of baths ___.!___ Lot size _____., --------------M---- Water Supply: Public system Community system E] Private F] Depth to Water Table f#. Character of soil to a depth of 3 feet: Sand E] Gravel [ISandy Loam.❑ Clay Loam E] Clay E] Adobe 0, Hardpan Previous Application Made: Yes ❑ No I- 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 froli nearest well-----------------Distance from foundation------------------- Material________-----__.__._-_____________---.---_____. ❑ No. of compartments------------ -- ----------Size-------•-------•----------------Liquid cep hl -----------------------. Capacity-•-- --------- # ---- i Disposal Field: Distance from nearest well_.,1VO.__.__Distance from foundation-__._!d_.______--Distance to nearest lot lin�e�___ __________ Number of lines.--------1__-__�----��--------`Length of each line------- - --------fr._.Width of trent _ -------------------- Type of filter material__j�___._5-�__Depth of filter material__-- �_ __.___.Total length------fit?_ ________________________ Seepage Pit: Distance to nearest well-----------------------Dis tance from foundation------------------..Distance to nearest lot line_______----.____- I ❑ Number of pits-----------------------Lining material---------- ------------Size: Diameter---------------- - ----Depth---------- -----------•---------- I Cesspool: Distance from nearest well-----------------Distance from foundation------.------------,Lining material_---------_..__-___________-______ ❑ Size: Diamete-r------------- ------------------------Depth---------------------------------- ----------------Liquid Capacity----------------------------gals. O �' Y I Privy: Distance from nearest.well---------------------------------------- ._Distance.from nearest building------------------------------------------ O i ❑ Distance to nearest lot line._..____---, ------------------------------ Remodeling and/or repairing (describe):-----G[ --------- - --- --•-- i^ " '''/ L f l ---------------- --- -- -------------- t - - ----------•--------------`---.....-------••-----------•--•-------•--------...----------------•------------ _..._ .. - I hereby certif that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, St e l s, and r4es,and regulations of the San Joaquin Local Health District. (signed}----- --_- ----------------`----------------------------------------------(Owner and/or Contractor) -- A I . Title ---- ---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed ori reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By _ __ DATE�----------------------------------------------------- REVIEWED BY-------------------------- �� -- ---- -------- ------ ------ --------------------•------------ DATE --- �------------------------------------------------------------------------------------------------ - BUILDING PERMIT ISSUED--------------•----- ----- - ------ DATE Alterations and/or recommendations:--- ----------------------- ------------ --------------------------------------------------••-•----•-•--------••----••-------- --------------------------•--------------------------------------------------------- --------------------------------•-------•---- ------ ---------------------- FINAL . INSPECTION BY:.-_ lh. =---------------------------------- Date-_ ..._ I SAN JOAQUIN LOCAL HEALTH DISTRICT t30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy. California Es-9-2M 145446 ATWDDD 12-54