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� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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 Ord' nce j - No549 JOB ADDRESS A O TION... `7 / Owner's Name------ -.--------------------•--------- ------------- -------------------------------------------- Phone- ---------------------------- Address. ------------------------- Address-------------- ------------ --------- --- ------------ DCS' Contractor s Name •-------- Phone-------_-------------- W& Installation will serve: Residence partment 3use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El- Number of living units: _/---- Number of bedrooms _Z Number of baths I----- Lot size j ----)-(... -____________________ Water Supply: Public system [§^-6 7munity system ❑ Private ❑ Depth to Water Table- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 6--wal*.an ❑ Previous Application Made: Yes 0 No p42--NM-Construction: Yes [�-P}e-❑ 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_ 0 MatediaL___ ._. No. of compartments......2--------------- Liquid depth_-.!�/_;e_ __- ---Capacity---- U0------- Disposal Field: Distance from nearest welh+�ea-s,-.Distance from foundation-le-_---.-.Distance to nearest lot line.____ r------------- g -S Width of trench....:A--f/y ...............D p Total length --------------------- Type 1 filter material-_,C-.%--------------Lenthhofffilter1m'aterial---� .__�s_ Seepa e Pit: Distance to nearest�iiwell`.'�'�'`�_---Distance f m fo ndation_S_92_-___.Distance to nearest lot line-- Number of pits------/-------------Lining material__- ---Size: Diameter- ------------Depth --- `�, Vi- Distance fi-om nearest well-----------------Distance from foundation--_-------.--------Lining material--.---_----._.___- --_.-- ❑ Size: Diamet&r------------------ ------------ ------Depth------------ ---------------- ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------.-------------------Distance from nearest building------------------_----------------------. ❑ '" Distance to.,.nearest lot line-------- ---------------------------------------------------------------------------------------------------------------------------•-------------------- � Remodeling and/or repairing (describe):------ ------------------------ ----------------------------------------------------------------------------------•------------------ ------•-------------•---•-----••---------------------•----------•------------•--------------------------------------•---------••------------•--------------------------- - ----------------------- ------•----------------------•-•---------------------------------------------------I------------•----••-------------------------------- ------• -------- - -•----- -------------------------------------------------------•-••-------•-------------------•------------------•--•---------------• ------••-•------------------------•---------- 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 the San Joaquin Local Health District. (Signed)---- - -- ------------------------------------------------- ----------------------------------------------- '='( d/crr Contractor)r q Tale (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 APPLICATIONACCEPTED BY----------------------- -------------------- DATE-----' ---------------------------------------------- REVIEWED BY DATE - ----------------- ------------------ BUILDING PERMIT ISSUED----------------------------------- -�_� DATE.--------------=.------ - Alterations and/or recommendations:--------------------------------- ---------------------------------------•------ -----------------•:�---1:-- ------••------- --- - ------------- ---------•------------ ----------- -----------._.... ... ----------------------------------- -------------------------- ----------------- ------- -------------------------•-------- Date------ y Sty`�' FINAL INSPECTION BY:----------- - -------- 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 145446 ATWDUD 12-54