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APPLICATION FOR SANITATION PERMIT Permit No. 0- (Complete in Duplicate) Date Issued 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 No. 549, JOB ADDRESS AND LOCATION----------------- lvo Owner's Namef ------------- ------------------ Phone-------- --------- f ----------• - - Address-------- Contractor's Name---------------------------------------` 4`Ir---------------- -------------------------------- ---------x- --------------- Phone-•---------------- Installation will will serve: Residence jy Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms INumber of baths ---I--- Lot size --------;P__4- Water Supply: Public system ❑ Community system * Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Y ❑ y ❑ y ❑ Adobe Hardpan-El' 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.) I Septic Tank: Distance from nearest well.____ _O_____Distance from foundation-----IU__..........Material___________`Q-w_- ; No. of compartments---"._.__ �-- Size -.. 1 Liquid depths 'Capacity-----�S'U--- D al Field: Distance from nearest well___-_-Q------- from foundation-------,......Distance to nearest lot line-- Number of lines---------------) Len th of each line______________ J, 9 .- -.Width of trench �y Type of filter material______�.�j-----_-___Depth of filter material-_._-___ _ �r___.__-Total length g �.. Seepage Pit: Distance .I to nearest well-._.______.__-_______Distance from foundation___________________Distance to nearest lot line-___________._- ❑ Number of pits-------- ------Lining material-------------- --------Size: Diameter-----------------------Depth------------------------- Cesspool: Distance from nearest wel! __Distance from foundation____---------------_Lining material----- E-I Size: Diamefer-------------- ---- ,Depth Liquid Capacity- ----- galsPrivy . :. Distance fromEl nearest v.�el! .�. �_ -- =Distance frorrr�eacest,.b�ildira _---- ' Distance to nearest lot line - -----------------------I----- --'------- 4 Remodeling and/or repairing (describe)__________________________ � ------------------•------------1---------------------------------•---- ------------------------------------------------ ------ 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 f the San Joaquin Local Health District. ` (Signed} -p -'---- -------------- ---------------- -------------- ------------------------(Owner and/or Contractor) . By: :-`----------------------------------- - - ------ -- --- ----------- -----(Title)= (Plot plan, showing size of lot, location ofsystemin relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- ---------------- DATE_ ,� REVIEWED E I IS ------------------ --------------------------- `-'-- --- --------------------------------- DATE---------- ---------------------------� --------•---------- BUILDING PERMIT ISSUED_____________ ;----- DATE___ Alterations and/or recommendations __-__. '_ c. / --- ___ ==- - --- --- ----- ---- - -------------------- ----- -- - - ------- --- ------ FINAL INSPECTION BY:...:° __6i '------ --- 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