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APPLICATION FOR SANITATION PERMIT Permit 7u� (Complete in Duplicate) I,��y S� Date Issued ----------- ----- Applica+ion is hereby made to the San Joaquin Local Health District fora.permit to construct and install the work herein described. This application is made in-compliance,with County Ordinance P49,. .. 0'?-7 JOB ADDRESS AND OCATION____--_ -_ Owner's Name-------- _- _�_!�_/�•�--_�-- - -- Phone Address----------- ---- ---�.. _.-_.---------•-: -- ----- ------------------------••-------•----------- •---------•------ ------- --- --- --- ----- Contractor's Name--._ __•, - k -- 0--- P Phone._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -_f_-- Lot size t � Water Supply: Publics stem h Y 0--Community system ❑ Private El ,Depth to Water Table ; Character of soil to a.depfh of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Y [I Adobe Hardpan ❑ Previous Application Made: Yes ❑} No [I New Construction: Yes No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well --------------Distance from foundation-_-----------__.--.Material __-_.________--___---- _---_--- I F1 No. of compartments-------- --- ---- ---Size------------------------- -----Liquid depth--- --------- -Capacity Disposal Field: Distance from nearest well___--.._...-___ Distance from foundation---------- ---._.Distance---- --to nearest lot line --_-__-.._____-�. ❑ Number of lines-----------------------------------Length of each line-------------------------------Width of french......___---__-_--- erial-- Type or filter ma# _ ..._-_.---______ Depth of filter material-__-...__---_- --------Total length--------------------------------------- I Seepage Pit: Distance to neatest well--__----------_ - -_---Distance from foundation-------------------- to nearest lot line---------- ------ ❑ Number of pits---------- ------ --Lining material--------------- , ---Size: Diameter----- -------- --------Depth i ----. ..... Cesspool: Distance from nearest well-_--' ___--Distance from foundation.._fd_f-------Linin Size: Diameter__....��6t ` g -- ------ ---- _ =-Depth----------4 ------------- Privy: Distance fr-om nearest well__ ________ ----- --------------Liquid CapacityacitY ------ F ------------ga ls. ❑ Distance to nearest lot line-------- _______ ___________-____----_ __ stance from nearest buildin9----------------------------------------- ----- �r _ ___ Remodei and/or repairing (descri' , r )i---------.-- ..._-. - i-------- ----/telfe --- t ---- ----------------------------------------------------- --------------------- -----------------------------------------------------------I—--------------------------------------- ---- ---------------------------------------- ----•-------------------- ----- = --- ----- ------ I herebycertif that I have y' prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. 3 (Signed):-•-------- - -- -- -----------------------------------------------------------------(Ow d/ or(Title)----_- an o r Contract her or) -------------------------••- -------------- __ Pot plan, showing size of to+, loco+ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------___i------------�,4 -- ----- ------------- -------------- DATE ------------- REVIEWED BY -------------- ---- ------ ------------------------------ DATE----------- - - ----------------------------------- IJILDING PERMIT ISSUED------------------------ -----•---------•------------ - DATE. --------------------------------•-------- Alterations and/or recommendations: x ..---•----•--- -----•---•----------•---------•---•---•- --------•- =------------------------------•-----------•--t-- --------------------------•----- -----------..---- - - --------------------- - ---------------•------•--------------- - FINAL INSPECTION-BY:-'_.. --- --- �------------ ---------- Date------------- ---------- - ~J b 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 345446 arw000 12-54