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APPLICATION FOR SANITATION PERMIT Permit No �Ull----__ (Complete in Duplicate) Date Issued ___Y14IS-r- Applica4-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----------Iy=f "Y---------- 0 �' $.---z---------------------------------•------------------------• •------------ Owner's Name---------------- ------------ ------ ---------------------------- - ------ Phone------------------------------------ Address-----------------------------------------------------------------------------------------------------------------------------------------••-----------------------...-----------------........---------------•---- Contractor's Name------------ -------------------- ------------------------------------------------•-- Phone--------------- ------------------- Installation will serve: Residence [;/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___h___ Number of bedrooms ___L Number of baths ___Z_ Lot size __"0 _A_1.54------------------------------ Water Supply: Public system Et�community system ❑- Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam Cray Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ 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.) `_ Septic Tank: Distance from nearest well_!"- -Distance from foundation__/ _Material_ �tF_LvQ`3? d�3 �Q No. of compartments_____2�_------Size___ )(_�X�.Liquid depth____________ _ __ Capacity_____ __ Disposal Field: Distance from nearest we€i_ $is#ante from foundation____ 0 f Distance to nearest lot line__ ------- e__ �r - ' Number of lines_________ __ _1__ _____ __ Length of each line-------7--S-- of french_______T ---______--.._- Type or filter maferial_5 ,--Depth of filter material----,��---------Total length---------- -------- Seepage Pit: Distance to nearest well__--------------------Distance from foundation--------------------Distance to nearest lot line________-_____ ❑I Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth--------------------------------- Cesspool: D+stance from nearest well-----------------Distance from foundation--------------------Lining material____-___._________________,_________- p� ❑ Size: Diameter--------------------------------------Depth-.---- --------------------------- -----------------Liquid Capacity------------------------ -gals. 1� Privy: :Distance from nearest well..._---------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line------------------------------------------------------------------ -----------------------------------------------•---------------------- Remodelingand/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 regula ions of the San Joaquin Local Health District. S� nedr -------------------------------------------------------------------------------------(Owner and/or Contractor) By:-------------------------------------------••-...------------------------------------------------------------------------------------(Title)---------------------------------------------------I-- --------- (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 APPLICATIONACCEPTED BY---------------------- V--,--------------------------------------------------------- DATE------------- --�----------- -- REVIEWEDBY---------------------------------------------- ----------------------------------------------- DATE BUILDING PERMIT ISSUED----------------------- ---------------------- --- - - ---------------- --• ----- - --------------- Alterations and/or recommendations:"__ � :- 5. .. . --------n. - - ------------------------------ -----•----------- •----• -----•------------------------ e _ _ -� .-------------3..= �~ -- --------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------------•-- ----- ------------------------ ------- ----- 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-4-2M ; Revised W-2100