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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued Applical-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. no JOB ADDRESSD LOCATI N � _-• - ------------------------------------------------------------------------------•--• -------- Owner's Name--- .�. _ ---------- ---- -------------------------------- ------ Phone------------------------------------ Address---------------- -----------------------------------------------------------------------------------------------................... Contractor's Name-----------------A. ¢ �-- ------..:.--------- -a---------------------------------- Phone&- � o...tt(g Installation will serve: Residence [Er-Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r� Number of living units: I___ Number of bedrooms __Number of baths Lot size -------- <ALd______________ Water Supply: Public system {]F✓Community system ❑ Private ❑ Depth to Water Table7---Ot. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay E] Adobe ardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Distance from nearest well_________________Distance from foundation------------.-------Material----------------------....__________._--_-__-.__. No. of compartments--------------------- ----Size--------------------------------Liquid depth-------------------- ----Capacity---------------------- -.1 posalfield: Distance from nearest well_ _Distance from foundat'son__/0_�____.Distance to nearest lot line-_._- 'a.____ Number of lines------- 1 rte.---- --Length of each line----------�`~ A --.Width of trench-----V__" -- --•-- Type of filter material-Z-5 !_%. .._Depth of filter material___-_-/f--_-__ g ---Total length --- ------------ r S e f: Distance to nearest well--�':`�--Distance om foundation----r!__S___.--.Distance to nearest lot line---- S Number of its...... __ __Linin material__ Size: Diameter__ z._._..-___Dept k- _ 4l -______---_ Cesspool: Distance from nearest well_________________Distance from oundation--------------------Lining material___._______-____________-__________. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------- ------gals. Privy: Distance from nearest we]--------------------------------------.----------Distance from nearest building----------.-- ------_-_______________._._. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- 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, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed) DAY &NIGHT Septic-1-ank-SwVice------------------------ - ------- --------- ----------(Owner an or Cantractorj 1206 5 Eldorado Ii0 2-7046 (Title]_-: --- -------- --------------------------- ,,, (Plot plan, ing size of Id °Icti6to�sysfem in relati ' to wells, buildings, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------- -- --- --- --- ------------------------------------------- DATE----------.t--�• �� ' a` REVIEWEDBY-------------------------------------------------------------- ------------------------------------------------------------ DATE-------------------•--•---•----•--------------------------- BUILDING PERMIT ISSUED......-----•-----------•------------------ ------------------- •---I---------------- DATE------------------------------------------------- Alterations and/or recommendations:________..._-___-_-___..____________ -_ _ ._ ------•-----------------------•--- --- - --- � i ------- -- - - - - . -: . ....:::..:.:. :: -------------------- ------------------------- :::::_: _.---------.:_:::-_-._-----------• ...-- -••------------ ----------------•-----------------.----- -------------------------- -------- -------------------------------------------------------------•-•----------------------------------- -- -- ----- FINAL INSPECTION BY--------------- ----------- -------------- Date------ �-------------------->_--------- '-``----�- -- -- --------------------------------------------------------- - JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145445 ATWOOO 12-54