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APPLICATION FOR SANITATION PERMIT Permit No. __ _._. {Complete in Duplicate) Date Issued Applica}ion 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 _�`f. { .__�.�__--- ---- - ------------------------------------------••-----------•-•------------------------------•-- Owner's Name . .. -- ° - ------- --------- Phone_�T'�--' -794 Address----------------- /b r ... ....... 'i�- '- ,.�. Contractor's Name-------- •-•--- - ------r----------------------------------- ------------------------------•---•---------------------------- Phone----------------------------------- Installation will serve: Residence [4]/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I-/---- Number of bedrooms r _._ Number of baths_ Lot size __.f``��–_--_X-_, Z_Q._a___----------------- Water Supply: Public system ❑ Community system ❑ Private [ epth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ® – New Construction: Yes R'_lTo❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) hh-- Septic Tank: Distance from nearest well. _GJ-_.•__.Distance from foundation--I�f.<__--i-----Material---_Vv'-'Y'--------------- No. of compartments--.__.. -----Size�1- _��ir , -.Liquid depth--L±L = �+ ----------Capacity---- tt :_Q_ Q Disposal Field: Distance from nearest well-0--------Distance from founda#ion _ _____..Dis#ante to nearest lot lines?_ Number of lines---.-- ----- Length of each Iine------d-.. -___-_.Width of trench.. iU ifot --- - ------------- Type of filter material---CLI"'t Depth of filter material----� _--_------.-Total length_- V Seepage Pit: Distance to neatest well----------------------Distance from foundation---.---__.-....._--.Distance to nearest lot line----------------- El Number of pits----------------------Lining material------------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_-_.-__-_-____-___-_--_-_-_._ El Size: Diameter------- ------------------- ------ -De th----------------------------------------------------Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- Distance -;-----_----_-____.___----_.Distance to nearest'lot'line-- ----- ------- - -------- ------------------ -••--•--------- --------------------------------------- Remodeling and/or repairing (describe)---------- -------------------------------------•--•--••-----•--------•----------------••-----•------------------`--------------------------------------- ---------------------- ---------------•-------------------------------------------------------------------------------------------------------------.------------------------------------------------------------------------ ------------------------ ----•---------•--------------------------------------------•----............ ---------------------------------------------------------------------------------------------------------------------- I 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 San Joaquin Local Health District. meg' Owner and/or(Signed} ----'f?___------7------- ---------------- -i --- --------------:--------------------------------------------- ( / 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 DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- DATE._ ------ „� REVIEWEDBY------------------------------------ ----------------------------------------------------------- DATL' .... ” i3UILDING PERMIT ISSUED ----------------------------------------------------•-•-• DATE-------------------------------------- - Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------- --------------- ---------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------•------------------------------------- - FINAL INSPECTION -BY::.- Date---------------------C3 ------------------------------------ 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 ; Revised W-2100