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cy\ It ell APPLICATION 'EOR SANITATION PERMIT Permit No. �P.�►-��- � (Complete in Duplicate) Date Issued Applica-lion 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 Or finance No. 49. ' JOB ADDRESS AND CATION...- - -- /• _�>- = ----------••-•---- ------ Phone--4� Owner's Name -- - -------- Address... .t ._ -- --------------------------------------------------------------•----------------------------•----------- Phone_ :�• Contractor's Name--- Installation will serve: Residence I ' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel YJ P--(2 Other ❑ Number of living units: __ ,l___ Number of bedrooms r2.- Number of baths _1_____ Lot size _la__ __y_!-P_(----------------------------- Water Supply: Public system ©i - Community system El Private F1 Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[2n 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 well_________________Distance from foundation--------------------Material---------------._________________---_,______-__. No- of compartments------------ ------- ----Size---------------•------•-------•-Liquid depth--------------------------Capacity--•- -------_ ! Disposal Meld: Distance from nearest well-________________.Distance from foundation__________-________ .Distance to nearest lot line.-,--------------- " ❑£ Number of lines ------Length of each line------------------------------Width of trench.------------------------------- J "� Type of filter material---------- --------------Depth of filter material-----------------------Total length-------------------------------- --- Seepage Pit: Distance to nearest well--,of-7 -----Distance from fou dation___Z�_. __.__.Distance to nearest lot iineAlIr----------- Number of pits--------- -----------Lining material__ 1 .size: Diameter_____ -.Depth---- ------------------ Cesspool: Distance from nearest well_________________Distance from foundation----_...______._--lining material---------- 6 11Size: Diameter------- ---------------------------Depth---------------------- --------------------Liquid Capacity-------------------- ----gals. 1Distance from nearest building---' Priv "Distance from nearest well---------- -------------------------------------- 9---------- ----------•------- ---------- Y ❑ Distance to nearest lot line--- ------------------------------------------j----------------------------------------------------------------------------4--------------- ---------------- ----------- Remodeling ------------------------------• ----4-------------- -- Remodeling and/or repairing (describe):�4 / l ------•------•------------------------------------------------------------------------------------------------------•-•----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanceseState laws, and rules and regulations of the San Joaquin Local Health District. ------------(Owner and/or Contractor) ----------------------------------- -------------------------------------------------------------- --------------- (Signed)_ •----------- {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--- - - ---------- REVIEWED BY DATE-- �"` -------- . - BUILDING PERMIT ISSUED-------------- ------ DATE - Alterations and/or recommendations-------------------- ••--------------••---•-•-----------------------•--••---- -------- -------------------• ------------------------------------- ----------------------------------- ---------------------- ------------------------ ------------------- ----•------•---------- -- --------------------------------------------------------------------------------------------------- --------------- ' - -------•---------------------=-------------------•---- FINAL INSPECTION BY:__ ------------- Date 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