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� Lam• h 1�1y ' APPLICATION FOR SANITATION PERMIT Permit No. __ ---------- (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. kol west 6th street JOBADDRESS AND LOCATION-----------------------------------=---•----------=-------------•-------------------------_--------------=------------•---•----- •-------------------------------- Owner's Name . . = on _ Maj-v-i_n--u&1e& : T ----------- ---- p ----------- Phone.. ---- - _._ .. ,r..t .. Address !!OI fest _-6 h__.Stre� ---------------•------------------------------------------1----------------- --------------- ---- --- 5 .Roto Rooter Sewer Service Ho. --266 Contractor's Name--------------------------- ------------••--------------------------------------------------------------------------------•---•-------- Phone----------------------•------------ i Installation will serve: Residence [3l Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----x_41-1 fNumber of bedrooms :? __ Number of baths _____I Lot size __ -___�___� df_______________--_-____:_________ Water Supply: Public system ® Community system [I—Private.[:] 'Depth to Water Table .3Q-1 ft. ` Character of soil to a depth of 3 feet:-.Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loarm❑ Clay ❑ Adobes] Hardpan ❑ Previous Application Made: Yes ❑ No![t New Construction: Yes ❑ No 13 TYPE OF INSTALLATION AND'SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 260 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material---_--------------------------------- ----------- Exsi®tSize #---------Liquid depth----------------- --------Capacity------------ ------ irig No. of compartments Disposal Field: Distance from nearest well -------Distance from foundation--------------------Distance to nearest lot line______=____-____- Exsis[�ing . Number of lines------------------------------------Length. of each line------------------------------Width of trench----------------------------------- Type of filter materia --------------- _.-'Depth of filter materia----------------------- length________-_-.__-__-____________._---..__-- r _ Seepage Pit: Distance tc neares well__none-- __ _-Distance frons f ndation______________-____-D•si mce to nearest lot line___-7-20'_ ___ R brzc ' [ Number of pits----------------------Lining material----_-_----------------Size: Diameter---3------------------Depth------- Q_�------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__.____.______._-___________.______- \� ❑ Size: Diameter-------- ----------- -----------------Depth_.__._------------ ----------------------= �____Liquid Capacity----=--'------ ---- =------gals. - - Privy: Distance from nearest well----------- --------------------------------------Distance from nearest building-------------------------------:---------- ❑ Distance to nearest lot line---- -- - ------- ". - Remodeling and/or repairing (describe]:---------------------- --------------- --- ---------------------------•----------------------------------------------••---------------------------------------------------- ---------- -•--------•------------------------------------- ------------------------------------ • -•--------- r --------------•--' 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. Roto Rooter Sewer Sex-vice - (Signed)--------- - - - - - -------- ------------------ -------------------------------- ----------------------------------------------------------------- -a-aw o&Contractor Ottot Schamber e Estimator By:-------- ----------------------------------•--------------------------•-----------------------------------------------------------( 'Titl )------------------------- ----------------- _-------------- (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- --------------- ----------- A ---------------- lterations and/or recommendations---------- -------- --------------------•--•------------------•------------------------------------------- ------ "`t----------- ---------------------- -------------------=---------•-------------------------- - •- ---- -----------------------•--------------------- ----------------- ------ •-----•---------------------------------------------------------- -------- -------;- FINAL INSPECTION BY:-- -----------=------------------------------=----------------- Date.= ='=' ------------------------_.---------==----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 930 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