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APPLICATION FOR SANITATION PERMIT Permit No. .-- -------S (Complete in Duplicate) Date'Issued Application 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 Coun Ordi ante No.-54 9. JOB ADDRESS D OTION----- - ____-- - - ------- -- - - - ------------------------------------- •-------------- ---- Owner' 4--- y� r --- Phone------------------------------------ Address-AA -----------------Address_ A ---t.� / ' ------- -- - - ------------------------------------------ -- ---------------------------------------------- Contractor's Name__.- _ __fig �.-----�..o-d1-- Pte_-_ CIL /►�L•0 Phone--*i�!__-- Installation will serve: Residence 040'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: .J__ Number of bedrooms _�L Number of baths -_f--_ Lot size ------ -----_X.0------------------- Water Supply: Public system JVCommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction:°-Yes ❑ No ❑ 'OL TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet. R Septic Tank. Distance from nearest well________________Distance from foundation-------------------.Material------------------------------------------------- No. -______--__________--_----___No. of compartments----------------/-----------Size--------------------------------Liquid depth--------------------------Capacity------ r Disposal Field: Distance from nearest well_4/ftta_.Distance from !! founds ' __ _.__.Distance to nearest lot Number of lines_ _ _ ____ ----Aength of each line---- -__ Width of trench___ __ r Type of filter mate ria l_ e_ _ _Bt/4Uepth of filter material ---Z_6-----------Total length_____ _____�________________________ Seepage Pit: Distance to nearest well----------------------Sistance from foundation--------------------Distance to nearest lot line___________.____- ❑ Number of pits----------------------Lining material-----------_----:------Size: Diameter------------------------Depth----------------------- ------ �► Cesspool: Distance from nearest well-----------------Distance from foundation___--- ------------.Lining material------------------------------------- J Size: Diameter--------------------------------------De th_____________--__t _____________Li uid Capacity ❑ IP -------------------- q ----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ❑ Distance to,nearest lot line---------------------------------------------------------=--------------------------------------------------------------- ---------------- -- L � 1 Remodeling and/or repairing (describe):---------�'"' '--------- { •-•------------•-----•--• ------------------•-----• i ---------------•---------------------•----•------------------'I---•-----------------------------------------------••---'"X___----------------IV ------------_ 3 L ____________________________________________ i ------------------------------------------------------------------------------------------------- -_____________________________-___-___--_______.-.__________________________-___-__---_--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Vandrulesnd regulations of the San Joaquin Local Health District. (Signed)------ - ----- ------ - --- ------------------- (Owner and/or Contractor) By:.--- --•t - ----------------------------------------------------------------------------- Title � } [Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be place on verse side]. p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- ------------0�- -------------------- ------------------------------ -- DATE REVIEWED BY------------------------------------------- _ DAT ', '! BUILDING PERMIT ISSUED-------------------------- - ------------------- ------ DATE Alterationsand/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- --------------------------•---------------------------------------------------------------------------------------------------- ------------------------ --------------------------------------- -----------—--------------------------------- -----------------------------------------------•-•---------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: -J/lL_ ---- --- ------------- ------ Date------- - d`` 1- { 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