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APPLICATION FOR SANITATION PERMIT Permit" . _5-- )-7-- (Complete in Duplicate) Date Issued .__- -5-- Application.is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. �`iis application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND CATIO _. J - ------------------- Owner's Name /f Phone �` --- Address --�• --------- • ---- -- ------------------.-.-.-.-.-.- --------------------------------------------------------I----------------.....------------- ------- .-. Phone- / Contractor's Name--- ----------------------------------------------------------------------------------•- f ' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- --- Number of bedrooms Z Number of baths ---/--- Lot size - -------------------------- Water Supply: Public system 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-W` Hardpan ❑ Previous Application Made: Yes ❑ Noo New Construction: Yes K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic T k: Distance from nearest well------------------Distance from foundation---_--------------Materiai----._ _-___-----_------------------. No. of compartments------- ------------------Size--------------------------------Liquid depth---------------- -----.---Capacity--•--- --------------- isposal Fe Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line--------__-....-. Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material---------------____-----Depth of filter material---.---- __Total length----------------------------------- ------ S .---- p Seepage it: Distance to nearest well- ��f---Distance from f ndation----/ ------Distance to nearest lot line--;--.F_-____ Number of its-------------------- Linin material Size: Diameter-_- 04_Dkeptn-_--- --- esspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------------------------- 1-1 Siza: Diameter------------------ -------------------Death----------------------------------------------------Liquid Capacity----------------------r-----gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------I❑ Distance to nearest lot line ------------ ----- --------- - Remodeling or repairing (describe}:----------e -..r !:_.---- f --- -• --- ----•------------------------------------•------------------------ -------------- ---I----- ------------------------ --------------------------------------------=--- ----------- ----•---------•---•-----------•--------------------------------•-------•-----------------•------------------------ ---------- ------- ---- ------- ---- --------------•----------------------------------------------------------------------------------------------------------------------- ----------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin ordinances, State laws, andr les and regulations of the San Joaquin Local Health District. (Signed) £ = F�. = (Ownern, Cont By:. - ... .= � ---------- {Title (Plot plan, showing size lot, location of sys+em in relation to wells, buildings, etc., can be pi on rever side FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- .. - DATE-;;_�------------ ----------------------------- ---------------------------------------------------------------------- REVIEWED BY---------------------------- - DATE BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------- ------ DATE------- - ------------------------------------------------- -------- ------------ -•- Alterations r. commendatio -- - E .--------- J� - - Y --------�1-.a- -- >s --------------------------_---- ------------- - ------------------------------ 4-_ � r7 FINAL INSPECTION BY: ------------------ ---------------- 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 0-52 Revised W-2100