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APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete in Duplicate) Date Issued .-'----------------�.J 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 No. 549. JOB ADDRESS AND LOCATION_..2_9�-__!-_ J---- =_ --------------4. ----------------- -- c�C Owner's Name--- '------ ---T ---------------------------------- Phone-4►7.f--t-7.1----- Address.------sr ... - Al- -6! -----+"r`------------------------------------------------------------------------------------•------------------------- Contractor's Name... VP ` . . -- Phone..'^ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other C] Number of living un-its: _#___. Number of bedrooms 9-- Number of baths 1----- Lot size _.1 ___ ._., _ ---_______________________ Water Supply: Public system Community system '❑ Private ❑ Depth to Water Table __y1rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No V 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 from nearest well-----------------Distance from foundation--------------------Material___------_-__-__....___--....__----._--__--. a . �wi wal► No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- `� �`'D'iisposal Field: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line_...____----____. Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------- Type of filter material------------- ---------Depth of filter material-----------------------Total length----.-----------------------------_------- So ___--- r � Soe a e Pit: Distance to nearest well-! `!►f__Distance from foundation._-__ _Distance nearest lot line---S40-._._ Number of pits____....--.___-__Lining material..-_.Size: Diameter____ p -- -.De th 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 fine------ ---------- -------------`---_-----------•---------------------------------------------------------------------- -•-------------------- Remodeling and/or repairing (describe):---._adof.�C..............._..._.__._.-.___._.___ __ ----------------------------------------- ----------------------------------------------------------------•-----------------------------------•------ -------------------------------------•-•------------------------------- a ---------------------------------------------------------------------••----------------------------------------.•_--••-----------------------•------------------------------------••-------•-•------------------- 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 regulations of the San Joaquin Local Health District. {SignedB-- i0",-='''0----------------------------------------------- - ----------(Title)_C..d- �d/or--C---o--n--tr--a--c-f--o--r} Y:--- (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------------- --}_v-- ------------------------------------------------------ DATE-------- .----- ------ --------------------- REVIEWED BY-------------------------------------------------------------- ----------------------------------------------------- DATE----------------------- .____. BUILDING PERMIT ISSUED---------------------•-------------------------------------------------------- ------ DATE----------------------------- ------------------------------- Alterationsand/or recommendations----------------------------------------------------------------•-------------------------------------------------------------------------------------------- -----I----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----•------------------------- --•---------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------- 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 8-51 Revised W-2100