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PPLICATION FOR SANITATION PERMIT Permit No. ._e ---------- (Complete _____._ (Complete in Duplicate) �� Date Issued ---!144-7- 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 q. 549. JOB ADDRESS AND L ATI. N-------�------ ---------------------------d... --------------------------------------------- ------------------------------ Owner's Name-------------- ........ r ---- - -- - -- - •- - . --- -- - Phone----.,----------------------------- Address------------------------------- ---- -- --• ----- _ 4-- --------------------- -- -------------------- -----------//-- Contractor's Name-------------------------------- �--- ----------•------ Phone 4--__, C 7 Installation will serve: Resident/ s-e Apartment House E] Commercial F1 Trailer Court ❑ Motel ❑ Other E]Number of living units- /-_- - Number of bedrooms .c;7_-_ Number of baths 1--_ Lot size ______ 4�, ��. .---____-.__•-.---__--_ Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Tablet ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&f Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ NOX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Taj. Distance from nearest well--- -----------Distance from foundation--------------------Material -__._-.__-.____-__------_---_--_-_-------____. No. of compartments--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity----------------------- D;s osal -eld 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----___-.-._-._---_---__-_-_______--- . �r Seepage Pit: Distance to nearest well--- --- -Distance fo dataon-__.�d_.._.__.,Distance to nearest lot line--- ---------- �� Number of pits__-.______________Lining material_-- .Size: Diameter--_� - -----Depth...�5___�__.__ ----------- Cesspool: Distance from nearest well-----------------Distance from foundation---.--------------..Lining material--------.---------------------------- . ElSize: Diameter--------`------------ ----- ------- Depth---------------- ------------- ---------------------Liquid. Capacity---------------------------gals- Privy: Distance from nearest well------ -------------------------Distance from nearest building-___---_--_-.------_-_-__-_---_---------. ❑ Distance to nearest lot {ire---------------------------------------------------------------------------------------------------------------------------------------------- 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, SVtae ws�and /rulespangulations of the San Joaquin Local Health District. (Signed)-------- x `----- ------------`---------::¢-------,------------•- ---------------------------------(Ow er and/or Contractor) $Y: ---------------- /�----_---.- - � (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----------------------------------------------------------- -----------------------------------------------------... DATE------- ------ ------------------------------------------- BUILDING PERMIT ISSUED------------------------------------ -- DATE-------------- Alterations and ---- or recommendations: ---• -- ---- ------------------•-•-----------------•-•------------------------------ ---------------------------------------- ----- -------- __, - ------------ ----- ---- -•� �-•`--- - `' --`-.--�-—----��G ----�- ------ ------------------------ •------------------------- FINAL INSPECTION BY:...__. - ----------- Date---------------_ ` �� 7 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 Ravised W-2100