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APPLICATION FOR SANITATION PERMIT Permit No.c .................. o (Cornplete'in Duplicate} �- Date IssQed A plication 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 y-Orclinanoe No, 549. JOB ADDRESS D.�OCATION... .-.--- -------_ r , Owner's Name_-. ....... --- •----. 'f`------------- - ---•----=---------------------------- Phone------------------------------------ r Address------- Z---• -----• -��=�1--- ------- -- ---------- -----------------------------------... 6 Contractor's Name--.-. -------- ---------------- -------------------1----------------------------------------- ------------------------------------------.- Phone---------------------------------- nsta ation will serve:, Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other/ Number of living units: _ ___ tuber of bedrooms ____ Number of baths _______ Lot size _ --___.___.__ Wa+er Supply: Public system eCommunity system ❑ Private ❑ YDepth to Water Table -------- ft. Character of soil to aldepth of 3 feet: Sand ❑ Gravel ❑ Sandy LClay Loam ElClay E] Adobe Hardpan ❑ Previous Application 1�lade: Yes E] No [v' New Construction: Yesoam No ❑ TYPE OF INSTALLAJION AND SPECIFICATIONS: (No septic tan or cesspool permitted if public sewer,i available within 200 feet4 _r ;_ _ Septic nk: Distancerom near sr well©_ ista ce from Ifoun artion_� _____________,Maters ______.____.__- __ ' ------ No. of compartmis----------- c 5iz -•x--> - ---Liquid odepth - ------ -------- Capacity---- -0-L) Disposdl Field: Distance from nearesi yuelf�_0.-__---- istance from foundation _------_"-.'".Distance to nearest lof line- -------------- ----------- Number f L ?T--- - Number of'lines--,'lines__ , -------�/______ Length of each line................. {c____.Width of trench._.____1►1_._..__ r Type of filter mate:'a _ f�'�_'f. -Depth of filter material------ .--------Total length------------- -- s ------- Seepage Pit: Distance to earrf�es noelDistance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits- ------------------11_Lining material-----------------------Size: Diameter-----------------------Depth__.------------------------------ Cesspool: Distance fro nearest well from founclation__..-.___--___-__..Lining material---_-___- __------._-__--__-_-----_ ❑ Size: Diamet r Depth --------------- Liquid Capacity --------- ; gals. Privy: Distance from nearest well'------------------------------------------------Distance from nearest building__-_-_._----------_---___- ._...-. ❑ _. ._ _ Distance to Barest lot line--------- ----------------------------------------------------------------------------------------------------------=-•---•------------------- Remodeling and/or repairing (describe):------------------------------------------------- ------------------------------- --------------------------------------- --------------••-••-•------------------------------ --------- ----------- ---• ------------------------------------ ---------- ------------------------------------•----------------------------------------- - ----------•-----}------------------------------ I ----------------------------- - --------------------------------------------------;I------- } -------- --------------------------------------------T---- --------------------------------------------------•--------------r--------- -------------- I hereby certify that I haw4 prepared thisiapplication and that the work will be done in accordance with San Joaquin County ordinances,,, ppState laws, and rules and regulafi ns of the San Joaquin Loch[ Health District. I 9 n e cl)- ----f ,.I•- --- ---•- -- --------------------------------------------- ---------------------- -------------- (Owner and/or Contractor} I plan,Y l" ; ' ' r Y ; - t {, ) ------------•------------------ ---------------- B :... ..... .--- Tale Plot showingsize of lot, location of s skm in relation to wells, buildings, etc., can be placed on reverse side),I i FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY("�- - ----------- ------------------------- DATE- ---- REVIEWEDBY-------------•--------------- ----- -------------------------------------------- --•-------------•--._ DATE l BUILDING PERMIT ISSUED-----_---,i--_ � --- = = Alterations and/or recommendations---------------- - ----- � --------------------------------------------------- y - --------------------- ----------•------------------------•------------------ ---------------------------------------------------------------------------------------------- - -- ------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION 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 ES-9--2M 10-52 Revised W-2100