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APPLICATION FOR SANITATION PERMIT Permit No. ..lt..A --�----_- (Complete in Duplicate) 7 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 ade in compliance with County Ordinance No. 549. $ -� � �"`; t a "` JOB ADDRESS AND LOCATION.. _-- �•_ S7_------Idol- -°v 5 --- --------------------------------- ---- --- - --------------------- Owner's Z -- - - Name--- ---------------- --•- -- ----- --•-------- Phone Address---------� �-- -- ----I- ••--�Y--'- Contractor's Name ------ Phone---�--8-1 .f------- Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms ---_"g7 Number of baths ---i--- Lot size -----/7_;�___- 5 Water Supply: Public system ❑ Community system ❑ Private [g Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E/ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ 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 w jII------T5_Distance from foundation---------/- - ----Material-------- - -- - - - - ------�-�- �------� No. of compartments-- - ------------ �X ! -----_-_-Liquid depth--_-.�'. -_ _ Size CapacitY �-- ------------ I - --- f Disposal Field: Distance from nearest well__ --_-----.Distance from foundation.---_-!©-- Distance to nearest lot line---L--.4-----_ -� Number of lines--------�---------------------Length of each line-_�_-'.+�-r'--_.Width of trench------ -"#- ---------_-_-__ Type of filter material.--- _--____Depth of filter material-----L_ 1-----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. Privy: Distance from nearest well------------------------------------------------Distance from nearest building----------------_-------------------- Distanceto nearest lot line--------- ------------------------------------------------------------------------------------ -------------------------- ----------------- Remodeling and/or repairing (describe):--------- ---- ----------=-------- ------------------------------------------------------------ ------------------------ -- ---------------------------•---•----------•------------------------•---- ------------- --------------------•------------------------------- ----------------------------------- ----------------------------••-------------------------------------•---------•----------------------------- -- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la`w-ss, nd rules and regu tions of the San'Joaquin Local Health District. (Signed)------------�-�=-`---... - (Owner r and/or Contractor) ---------- By:__------------------------ ---------------------------------------------------------------------------------------- -------------(Title)---------- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR RTMFNT USE O LY ! -' r°rLe .-.. DATE APPLICATION ACCEPTED BY - REVIEWEDBY ------------------------------:--------------- ---------------------------------------- DATE------------ BUILDING PERMIT ISSUED DATE Alterations and/or recommendations---------------- --------------------- ------------------------••------------ -----------------------------•-------------------- ----------------------------------------•-------•---------------------------------•-------------------------- -----•-------•- ------------------------------------- ---- ---------------------- ---------=---- FINAL INSPECTION BY:-------------°---�--; ---------------------- Date ��. � - � f r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Streef 814 North "C" Street i4 Stockton, California Lodi, California Manteca, California Tracy, California E P-9-2M 10-52 Revised W-2100