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APPLICATION FOR SANITATION PERMIT Permit No. ....-/---� (Complete in Duplicate) S1 Date Issued A lication kberebypp made to the San Joaquin Local ealth Di tract for a permit 4ctructr and install the work herein described. This application is made in compliance with County inanc o. 549. JOB ADDRESS AND LOCATION- - ---- .--- -- -------- Owner's Name Phone ' = ��( Address------------------------- Contractor's Name----------------------,d- v":41L_____C -- - ---- - - - ------------------------------------------- •--=----------- Phone.-f-7- Installation will serve: Residence % Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _./___ Number of bedrooms _��_ Number of baths __/___ Lot size ____ _____J2_4_--- ______________ Water Supply: Public system .K Community system ❑ Private ❑ Depth to Water Table ,40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayL m ❑ Clay ❑ Adea�� Hardpan ❑ Previous Application Made: Yes ❑ No I( New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: XN " No septic tank or cesspool permitted if public sewer is available within 200 feet.) Nlk is TaEk. Distance from nearest well______________ __Distance from foundation___________________ Material_________._________._..--__-- �. No. of compartments--------------------------Size--------------------------------Liquid depth------------ - -- --------Capacity----------------------- sal Fuld` Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_____.___._____ Number o-i lines------------------------------- ---Length of each line-----------------------------.Width of trench.----------------------.----------- Type of filter material________________________Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well__4�41b�' -_____Distance fr �fgunclation__;L-4_�'_..Disfance to nearest lot line__ Number of pits..... --------------Lining material-�_'-----------/-___.Size: Diameter----CU----____-Dept n_..4-_ __--_-__..______.___ 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)---------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------•------•--------------------•-------------------------------------------------------------------- ----------------------•---------------------------------------------------•- ----•---•---------------------------------------•------------------------------------------------------------ ------------------------------ I hereby certify that I have pr ed this applicaf, n and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rut e�nd{{ egu' ions of San Joaquin Local Health District. lf -------------------�_ . (Signed)-•----•---------•-------- ----- ;- Contractor) By:._.----•---------------------------------------------------------------------------- (Title} r -------------------------- ------------------ (Plot plan, showing size of lot, location of system in relation wells, buildings tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- F ---- - ------------------------------------------ --------------------------------------- DATE_ REVIEWEDBY----------------------------- -------------------------------------------------------------------------------- DATE---- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------- -------------------------------------------•----- Alterations and/or recommendations-------- ------- ---------------------------------------------------------------------------------•-----•----------•-----------------------•------------------- ---------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- -----------------------•--- ------- ------- --- --------------------------------- F17) INAL INSPECTION BY----------- --- Date- '�-zJ 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 10-52 Revised W-2100