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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a e mit to construct and'install the work herein described. This application is made in compliance with County Ordinance 549. JOBADDRESS AND L TIO )..� - - ---- - ------ ----------------------------------------------------------------------------------- Owner`s Name-- ---•- ------• --------------------------------------------------- ------ Phone----- Address----------------- ----Address------------------------ Contractor's Name----------------- - -------- ----- Installation ---Installation will serve: Residence ❑ Apartment Housejy Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units-/14- Number of bedrooms _ Number of baths _ Lot size _ _D__�.r�2u_-_______________ Water Supply: Public system Community system E] Private ❑ Depth to Wafer Tablec �ft.`� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E❑ Hardpan` Previous Application Made: Yes L] No New Construction: Yes E] No �` TYPE OF INSTALLATION AND SPECIFICATIONS: lL (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- /, No. of compartments--------------------------Size--------------------------------Liquid depth.-------------------------Capacity----------------------- Disposal Field! Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line----------------- -�14, Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------------------- Type of filter material-------------------------Depth of filter material----------------- -_ Total length-----------------------------___.----_---- nnn Seepa Pit: Distance to nearest wellyy[. _Distance ors�fo ation .__-__ - --_ Dis#ace to nearest lot lin __-_ 1f' Number of pits------ ------------Lining materia _ _ __ Size: Dia eter_____. -------------Depth ____•_ J Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ElSize: Diameter--------------------------------------Depth------=--------------------------------------------Liquid Capacity---- ------------------gals. Privy: Distance from nearest well------.------------------------------------------Distance from nearest building----_--_---_------_---______-------__---_. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)--------------00 ----------------------------------------------------------------------------------------------------------------------- I -------------•---------.-----.-------------------------------------------•--------------------------------------------------------------------------.--------------------------------- --------------.-------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and les nd regulations of the San Joaquin Local Health District. (Signed).- --- -- - -- - ----------- ------------------------------------------------------------------------------------------- -- ----------(Owner a d r Contractor By:------------------------ -� ------ f- ------ (Title)- - ------------- .fro-------- (Plot plan, showing size of f, location of system in relation to wells, buildings, etc., can be place od n reverse side ),,,O' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- �� /--------- ------------- ------------------------------------------------------- DATE-- REVIEWEDBY------------- �V----- - ------------------------------------------------------------ DATE BUILDING PERMIT ISSUED DATE Alterations and/or recommendations-- --------------------------- - _--------------------------------- --- `rn - ------- fi r»-t`�vW --- -- ---------- ---- - ----------------------------------------------------------------- ---------------------------------------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:-------- / ---------------------------------------- Date------- a 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 8-51 Revised W-2100