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APPLICATION FOR SANITATION PERMIT Permit No. _ t----- � � II (Complete in Duplicate) // ,1 Date Issued �p lkation 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 o. 549. ,. - --------------- �j JOB ADDRESS AND LOCA'TION..- ---------------------r-------------------� Owner's Name- -------f. - ----- ---- ------------------------------------ Phone---C ----- _ Address---- - -- ---------------------------------------------------------------------- ------------------------------- Contractor's Name------------- .�. - - :- --------------------------------------------------------- Phone : Installation will serve: Residence Apartment House ❑ Commercial F] Trailer Court E] sMotel ❑ Other E]Number of living units�l _/_ Number of bedrooms mg?— Number of baths __/__ Lot size _ ! __ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth .�f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob� Hardpan ❑ Previous Application Made: Yes ❑ No New New Construction: Yes�No ❑ `err �� TYPE OF INSTALLATION A'ND SPEC 1fF CA-"IONS: !� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ASetic Tank: Distance'from nearest well------------------Distance from foundation--------------------Material----._-_--__---_-_---- -_---_-_-------------_.--. ' - impartments-------- --Size------ ---Liquid depth--------------------------Capacity----------------------- Disposal Field: Dotanceo ---------------- ---------------------- 7 ' _ from nearest well----------------- from foundation--------------------Distance to nearest lot line___-___-----__---� u e T of f lines-----------------------------------Length of each line -Width of trench yp filter ter material_-_______--_______-_-_Depth of filter material-----------------------Total length_-__----_-____---_____--__---_--_------./ Seepa a Pit: Distance to nearest well_�ryL�' ___Distance fr foun tion__ _______.Dis 1a e to nearest lot line____ _ e Number of pits------- -----------Lining material___ Size: Diameter-___-a --__�.__._Depth-----� --------------- C -------____-- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material_______-----_-----__--____---_--_--. ❑ Size: Diameter--------------------------------------Depth------;---------------------------------------------Liquid Capacity__-----------------------gals. Privy: -------------------------------------------------- from nearest building __-_-_ -._-_______---_--__-_--._----. I ❑ Distance to nearest lot line-_-_ Remodeling and/or repairing"(describe)------- �-------------------------------------------------------------------------------•----- -------------------------- 11 --------------------------------------------------------------•-------------•------------------------------------------------------------------------------------------:---- - ---------------------------- ------------------------------------------------1(--------- - ------ ----------------- --- -------•--------------------------------- ---------- --•--- --- -- -------- ------------ --------------------- ' hereby certify that I have prepared this application and that the work willr be done in accordance with San Joaquin County ordinances, State , and r-ul n 'egulations San Joaquin Local Health District, w (Signed)--------------- --- 4------ --------- ---------------------------------------------------------- -- Owner and/ Contractor) By:-------------------- --- - ------------------------------------------(Title)- -- -- - _!- - --- ----- --- ------- I , . (Plot plan, showing sine lot', ocatio of system in relation to wells, buildings, etc., can be p on reverse sid FOR DEPARTMENT USE ONLY ,1 APPLICATION ACCEPTED BY --- = DATE------Il--- 3.3------------------------ REVIEWED BY ------- ------ -------------- DATE BUILDING PERMIT 155UED (------------------------------------------------------------------------------ ------------------- DATE-------------------------------------- ---------------------- Alterations and/or recomme4lations---------------------------- --------- -------------------------------------------------------------------------=---------------•------------------------------- II I! ;" � i FINAL INSPECTION 8Y- ------------- 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 it ES-9-2M 8-51 Revised W2)00 it