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APPLICATION FOR SANITATION PERMIT Permit-No. (Complete in Duplicate) Date Issued -- --- ---- gA plica4-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. application is made in compliance with County Ordina e Flo. 549. JOB ADDRESS AND --- ---------- /V------ ----------------- J--- T------;.4 ---------------- Owner's Name--------- -k- ...LOCATION------ --------------------- ------------------------- -------------------------------------------- Phone---------------- ------------------- Addres ------------- ----------ON- -------------------------------------------------------------------------------......... Contractor's Name------------49--Ll.v- ------------------------------------------------I---------------------------------- ---------------- Phone--------------------------------- Installation will serve: Reside'rice [Apartment House E] 60'Mmercial E] Trailer Court F] Motel E] Other E] Number of living units: --- Number of bedrooms ___/_. Number of baths ---4 Lot size ------7- --------------------- Wafer Supply: Public system El Community system F] Private Depth to Wafer Table /teft. Character of soil to a depth of 3 feet:-Sand [] Gravel E] Sandy Loam Clay Loam Clay ❑ Adobe 13- Hardpan a� I E] El Previous Application Made: Yes E] No [ New Construction: Yes P3--No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool:permiffed if public sewer is available within 200 feet.) Septic Tank: Distance from-,nearesi well----kV------Distanc- fpm fg)jndati n____._-e�-3r--��:'-.Maferjal------/f c7a- ---------------------------- - 2--- .. ......... No. of compartments-------------'2------'.___Size:_____' -.-y---FY-Fiquid dep�h------j�a---- Capacity----- Disposal Field: Distance from nearest well---46.0.......Distance from.foundation-40.---------Distance to nearest lot line___- Length of each line__________4. 0---- Number of lines--------------/--------- 3- 41-�Vidth of trench------------ Type of filter,mate ......<-,,.Depth of filter mater�al---- ----Total length-----------4--a---L'A Seepage Pit: D�stance to nearest well--------------------Distance from foundation-------------------Distance to nearest lot,line---------- --- Fj- Number of pits --------------- Lining, 'Material--'-- ----------------Size: Diam8�fer--- -----------------*'---Depth---------'-- Cesspool: Distance from nearest well_________________Distance from foundation_________,__._:_.__ Lining mafbrial------------------------------------- ❑ Size: Diameter-----.----_- --------------------- Dept h-----------------------------------------------I-----Liquid Capacity"----------------------••--gals. Privy: Distance from nearest well:-.____-___._ ______________________________Distance from nearest building__,---_-_..__________-_________.______._. ❑ r� Distance uilding---------------------------------------- Distance to nearest lot line----- ---------------------------------------- Remodeling and/or repairing (describe W &U ---------------- 0-6 v ------ -----Y.:------ ----------------- ------------------- ------------------------------------------------------------ ------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ti --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ --------------------- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, an r e, a r�gulaflons of the San Joaquin Local Health District. (Signed)----- .. .. ... ..... . ..................................................;--------------------------------------------------------(Owner and/or Contractor) By:.... -----------------------------------------------------------------I------------------------------------------------------------(Tif le)----------------------------------------------------------------- (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---- -- ---------------- ---- .....0006-1--------------------------------------------------- DATE---------I- � !" REVIEWED ATE---------- REVIEWED BY--------------------------- I r .. ----------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED---------------- ------------------------------------------------------I------------------------------- DATE Alterations and/or recommendations ----------------------- -------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- -------------------------------------------------------------------------------------------------------- -------------------------------------------- -------------------------------------------------------------- = ---------------------------------------------------I----------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------ ----------------------- ------------------- ----------- ------ ------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.........G -----w---------- ------------- ------ Date...... - - i-�F� SAN JOAQUIN-LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stree+ $14 North "C" Street Stockton, California Lodi, California Man+eca, California Tracy, California ES-9-2M ; - Revised W-2100