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APDL C'TION FOR SANITATION PERMIT Permit No. ----- O_ (Complete in Duplicate) 3 Date Issued Application 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. I JOB ADDRESS AND LOCATION 2 0 -. Gr ___ --------------_ ------------------------------------- ------ Owner's Name------ - . - ------------ v_ ----------------------- -------------------- --- _. Phone--------------- F _________________________ ------------------------------------------------- Contractor's Name_______________________ Phone. Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court Number of living units: _______ Number of bedrooms _ E] Motel [] Other ❑ Number of baths :_�.___ Lot size ....140 _•_ /g ---------------------- Water Supply: Public system ❑ Community system 2 Private ❑ Depth to Water Table K�, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ { Previous Applica+ion Made: Yes ❑ N016 New Construction: Yes � No ❑ TYPE OF INSTALLATION AND•SPECIFICATIONS:— (No septic tank or cesspool permitted if pu��bJJlic sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----AM-----Distance from foundation____-1 D_ No. of compartments..._ p Material__ --�l�1 1_ _------ G ------Size------f si� r �Sd ---------Liquid depth---- Capacity Disposal Field: Distance from nearest well--..- �`----Distance from foundation__-2 _-r.------Distance to nearest lot line__- --.r__. �''� Number of lines____________________-.___ Length of each line-_-_ -___._ 1 9 .__ Width of trench.-------- -y- Type or filter material--------1Yz_______--Depth of filter material___.__]-6-�-- ---_Total length._____-_-- . -- ----- Seepage Pit: Distance to nearest we11_.__--__-------------Distance from foundation------------.-------Distance to nearest lot line_-.__---_--_-.-- ❑ Number of pits------ ---- --- ------Lining material----_---_-- size: Diameter----_--- --- - ------ Depth- Cesspool: -------------�--. ❑p Distance from nearest well---------_____--Distance from foundation---------_--------.Lining material_.________-__..___.__- Size: Diameter------------------------ -------------. ----- �---__.Depth- --------------------------- ---------------------Liquid Capacity----- ------- ------- -----9als. Privy: Distance from nearest well ------- ----- =/ _ Distance from nearest buildin ❑ Distance to nearest lot line----- ----------------------- - -- ---------------------------------------------sg---------- ------- --------- ------------- Remodeling and/or repairing fdescribe)-------------------- - . - --------------------- _____________________________________________________________________________________s_-____.__.____._________.___-_____.___-____..__-_____-____-_.._-_-______«___-________':._.___-_____._______._.._-__.__ ...... I hereby certify that I have prepared this application and that the work will be done in accordance wi ordinances, Statte +h San Joaquin County laws, and rules and regulations of the San Joaquin Local Health Distr*7) ct. (Signed).- �1 Q� �-t� -------------------------------------- - ------------------------------------------------------------- ---•----(Owner and/or Contractor) - - - -- - - -- -- - - --- -- ------- (Plot plan, showing size of lo+, Iota+ion of system-in-re- -l-ati-on--t-o--well-s,-buildin-gs-,--a+c- ., can be---------(Title)----------------------- ------. -----placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY---- _________________________________ REVIEWED BY---•--------- -- ---------------'- -- ----- - ------- ---------- -----��. ---------'---.------------------ ------- DATE------- -- �•.'---�r� '�-- ------- -------- BUILDWG PERMIT ISS UED_ DATE -------------------------- -------------------- 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 W-52 Revised W-2100