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APPLICATION O SANITATION PERMIT Permit No. f 1 , (Complete in Duplicate) �� Vl 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 Ordinance o. 549. JOB ADDRESS AND LOCATION------------ t` ?-------------- ----- ------------------ < Owner's Name------------ ! ,®^1'�_,----------------------------- ---------- Phone------------------------------------- Address------------------------------- -------------------------------------------------------------------•----------------------------------------------------------------------------- Contractor's Name--------------- s—---------------------------------------------------------------------------------------------- Phone------------ ---------------- Installation will serve: Resides)� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ot er ❑ Number of living units: j---- Number of bedrooms ___�tJumber of baths _- -__. Lot size ----------6--AT--__. 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 Hardpan ❑ Previous Application Made:;i'Yes ❑ No Ix New Construction: Yes No ❑ 1 v TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic lank: Distance from nearest well______Distance fr m foun ation----�_ ______.Mater' I-------------------------------- _______________ �- ", . No. of compartments- -- ------------------- Size- _ r _ g� - -- __--Liquid depth"----_-_-_- --------------Capacity___-- - - ', yy�� yy Disposal Field: Distance from nearest well____ '__.Dista'n e-from foundation___ © P Agpce to nearest lo_t ln _� __- _ -- Number.of lineLength of each line------ SW h of t rench____ _Type offilter material _Zy _ De th of filter material_________ _-_____Total 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: Diameter------------------- ------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well-______________________-.____________________Distance from nearest building ❑ Distance to nearest lot line--- ----------------------------- ---------- ----------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-----------------•.-.------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- -----•--------------•----------------------------------------•------------------------------------------------------------------------------------------- ------------------- ----------------------------------------------=----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- --------------------------•----------- ---•------------------------------------------------------------------------------------------------r-------------------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St fe laws, and rules and regulations of the San Joaquin Local Health District. �/ (Signed) ''•`' /R .; lel- ��' ---------------------- ------{Owner and/or Contractor) By:---------------------------------------I--------------------------------------------------------------------------------------------(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______________ __ - IV� -- ---- ---- ------------------------- DATE--------�'--�----- ------------ REVIEWED --------- -REVIEWED BY -------------------- ---- ------------------------ - DATE------------------------------------------------------------ BUILDING PERMIT ISSUED° -----------------------------------------------------------------.- DATE------------------------------------------------------------- Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------"-------------------------------------------------------------------------------------------------------------------------------------------•---•-- ----------------------------------------------------------------------------- ---------------------------------------------------------------------- ------------------------------------------------------ FINAL INSPECTION BY:--------- l G Date---------- ` ---------------- SAN !/ ` `r -------------- 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 9-51 Revised W-2100 . 7 J '^