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gyp k APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate)' �, ji-/ Y-1,51 / Date Issued ----__ -- 3 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 wit ;qunty Ordinance No. 549.„ JOB ADDRESS AND LOC TI N______7_.�eo Owner's Name------------ - ------ ------------ --• ---- -------------- ----- Phone------------------------------------ Address------------------------------------------------------------------------------------------------ -------------------------------- Contractor's Name----------------------_------ ------ ---------- -------------------------------------------- Phone----------------------------------- Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ I Number of living units: ----- Number of bedrooms _Number of baths ---I-__ Lot size ....._-r� - ___1_� --------------------- Water Supply: Public system ommunity system❑"Pr"Evate ❑'Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe Eg---H dpan ❑ t Previous Application Made: Yes ❑ No New Construction: Yes to ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,,��II 6 Septic Tank: Distance from nearest welL_1--`!- CDista c frpQ+��+ found tion---- _:_..__.Material-------------------------- _.___C �_'_______________________ No. of compartments.-______ .`�____-Sizir_`_ _�-Liquid depth-_-_-_._- ------------Capacity) ___--- f Disposal Field: Distance from nearest well----l-1-d" fDistance from foun ation-_�. j_....bistance to nearest lot line-. yupmber o1 line — _Length filter h materia E---- Width of trench. _-- � ----t------------- - T e of`filter material t_7_..___ ___ p Pi-----Total length----•-•- --- ------------------- 1, Seepage Pit: Distance to nearest well------.---------------Distance from foundation----------- ------Distance to nearest lot line________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distan#e from nearest well-----------------Distance from foundation-----------1-.-_-..Lining material-____________________________________ ❑ Size: Diameter-------------------------- -----------Depth_------------------------------------------- -----Liquid Capacity----------------------------gals. Privy: Distance from nearest --:_-._---------------------------Distance`'from nearest building------------------------------------------ E Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------- ------------ Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ -------------------------------------------------------- ----------------------------------------------------------------------11---------------------- ------------------------------------ ----------------------I------------------------------------- - ----------------------- 4 .:a la ------ - -----------•-----------------------------------------------------••------------------------------------------------------------------------------------------------------•-----•--------------------------------- L - ---------•------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. r (Signed)----- ---- 1------------------------------------------------------------------------------------------(Owner and/or Contractor) BY: ----------------------------------------------------------------------------------------(Title)---------------------------------------------------------------- (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 APPLICATION ACCEPTED BY--------------- ------------------------------------------------------- DATE---/ .�. . REVIEWED BY-----------------------��...,.�.�--------------------------------------------------------------------------------------- DATE----------------------------------.:.--- ------------------- BUILDING PERMIT ISSUED]------------- -••-------•------------•------------------------------•----------------------------- DATE-------------- •----• I --------------------------------------- r'1 -- e terations and/ r rec mmendation -----r------- ..... - ----------z r --------------------------------- --------------------------------------------------------------------------------------- t. ------------------ ---------- --- ' �i�FINAL INSPECTION BY:----------- 4 --------------------------------- Date-------�--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Qat Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Rev>sed W2100