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APPLICATION FOR SANITATION PERMIT . Pe-mJ1No. 7.l(... -.. (Complet® in Duplicate) Date Issued .---_ -�--- - Application is hereby made to the San Joaquin Loca! ealth District for a permit to construct and install the work herein described. This application is made in compliance wit Count ' rdinance 549 JOB ADDRESS LOC TI N.... ---- ----- ----- -------- --- - ------------------------------------ Owner's Name---- _ -------�- ------------------------- ..---------------------- --- Phone ------------------- -- Address--------�------- Contractor's Name------ ------------ -------- - --------------------- ------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Resident- 6 . Apartment'House ❑ Commercial ❑ Trailer Court ❑ Motel.E] Other E]Number of living units:II---- Number of bedrooms -�-- Number o aths -- - Lot size ---=7s-Xlc�c _r------------------ , Water Supply: Public system E] Community system El Private Depth to Water Table -------- ft. "V Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loam L] Clay E] Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes No ❑ } TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank b'r cesspool permitted if public ysewer is available within 200 feet.) Sep t4 ank.- Distance from nearest well-----------------Distance from foundation-------------------Material-_-----------.-----.---------------..-___------. �. (ca aci# o1 of compartments I Size,.... Liquid d pth------' -- - - Di }jos field! Distance frm nearest well.-Yr `Distance from foundation--_l-IC__ €� ance to nearest lot Ii - ---.-... Type of filtFer oiiines----------- -- - -- _ Length of each line_--_------_7< - ---..Width of trench --_--__ ------------.--___._- - ----- --- ---- er materi r-�- epth of filter material----- �.�_------Total, length------ ---.--_---------------------- Seepage Pit: Distance t1LneZ3rest'Well"'""__- - -''Mitance from foundation--------------------Distance to nearest lot line---------__-____. ❑ dumber of pits------------------I--Lining material-_-------.---.--------Size: Diameter-----------------------Depth--------------------------------- 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-------- -------------- ----------------------------•------•------------------------------------------------- ----------------------------- Remodelingand/or repairing (describe)---------- ----•--------------------------------•--------••--------------------------------------------•---•------ t--------------- ------------------- -------------------------- ------------------ --------------- ------------------------------------------------•----•--------------------------- --------•-----„-_------ --- ----------_-----------------• --------- --=---------------------------- - --- I—— — _ . �-- I -------------------•------------------------------------•---••---------------------------------------------...----------------------•--------- ----- ------------------- -------------------- ------------------------•---------------------------------------------------------•------------------------------------------• -----------•-------------------- ------- I hereby certify that I have prepared this application and that +he work will be done in accordance with'San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- ----•- ------ -- -------- --------------------------- -------------------------------------------------------- --------{Owner and/or Contractor BY:--------•---------------------------------------------------------------------------------------------------------------------------(Title)--------------------- ------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---- - ------------------------------------------------------------------------------ --- DAT -- ---- ----,--- ---------------------------- REVIEWED BY --- --- -- ------ DATE ------------------- ------------- BUILDINGPERMIT -------------------------------------------------------------------------- DATE------- - --•------------------------------- -- Alterations and/orTrecommendations:. -'---------------- -------------------------------------------------------------------•--------- �----------------- ---------------------------------------------------------•----------------•------------------------- ---------------- ----------------------------•------------•-•--------------•------••-----------------------...---------- -----•---------------------------------------------------------------------------------------------•---------------------------------------------------------I---------------------------------------------------------------- ------------•---------•------------------------------------------------------ --------------------------------------------------------------------- --------------•- -•------------------------------------------------------- ----- --------------------------------------•----------------------------------•-------------- ---•-•--------- -----•----------------- ------•--------------------------------------•-------- FINAL INSPECTION BY----------------,By �------------------------ Date-------------------X/1 ------ ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Stree+ Stockfon, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100