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APPLICATION FOR SANITATION PERMIT Permit No. -- ..---__. Iv _ (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. lglo JOBADDRESS D LOC ,ON � '�C -- ---------•------------------------------------•----------------- -r--------------------- Owner's Name_- ---- - - hon/ _. ,�._� �.��f _' Address- Contractor's' Name----- - ----------------------------------------------------- --•-- Phone. - ----- Installation will serve: Residence' Apa ment House ❑ Commercial ❑ Trailer Court ❑ Motel Other E]Number of living units: _/__._ Number of bedrooms Z,_. Number of baths _ ___ Lot size __1 ___________________________ Water Supply: 'Public system ❑ Community system ❑ Private Depth to Water Table,'W_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa MA Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: Yes ❑ N010 New Construction: Yes ' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well__ _ __---Distance from foundation_ _/�_� Material_____ p � / ,✓ , f ''��€ '---- ---------------- No. of compartments_eZ_____________ __SizeL -�1�X _Liquid depth _ -__________Capacity-____ p0____ , Disposal Field- Distance from nearest well_------Distance from foundation,��______-_-Distance to nearest lot line__'_______. XNumber of lines_______/______________ Length of each line_______�Q_____-__._-Width of trench------_ ? _______________ Type of filter material.rl _-____Depth of filter material----Af...........Total length----------455�e�19------------------ -` Seepage Pit: Distance to nearest well---------------------Distance from foundation.................__Distance to nearest lot line_______-_________ ❑ Number of,pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------- ------ Cesspool: Distance from nearest well______________ __Distance from foundation-------------------- material-------------------------------- _ __. � _ ❑ Size: Diameter------ -------------------------------Depth-------------------__--------------- - -------------Liquid Capacity---------------------------gals. __Distance from nearest building - Privy: Distance from nearest well------------------------- -- -------- ----- g----------------------------- - ----<_ . ❑ Distance to nearest lot line___________________ r` Remodeling and/or repairing (describe):__ ---•-------------- ------------------------------------ ------------- -----------------------------------------------•---------••------------------------ ------•--•---------------------------------•---------------------- :-•------ --------- I hereby certify that l have prepared this ap-�Iication and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. (Signed) �D __ -------------=--------- ------------------------------------------------ -------------------------- ----(Owner• nd/or Contractor) . By:_- --------- . ---- •------------------------------------------------------------------------------------- (Title)-_, � ''` -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can-be pl. ced on re erse FOR DEPARTMENT USE. ONLY APPLICATION ACCEPTED BY------------------------------ -------------- - ----------------------------------- DATE / / y�� REVIEWED BY DATE / ��F --- BUILDINGPERMIT ISSUED---------------------------- -------- - ---- -- ------ DATE--------- ------------------------------------------•------- Alterationsand/or recommendations:--------------------------------- ---------------••---------------•---- ------------•- ••------------------•-•----------------------------------------------- -------------------------------•--------------- -------- FINALINSPECTION 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 ,r rc 0 'AA D-7-4 W_91nn