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APPLICATION FOR SANITATION PERMIT Permit No. . (Complete in Duplicate) y Date Issued _e?'l 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 County Ordinance No, 549. 02-0 -06 ' lp w A. JOB ADDRESS AND LOCATIONq .t,,.._1' __ ---- I • -- ------��aa---- "----------------------------------- Owner's Name--------14"� p-��'�'�_ -------------------------------------- ----- ------------------------------------- Phone-------------------------------- Address--------------------- z-----------------------•-- Contractor's Name_/_447 Irkv ------•------- Phone----------------------------------- Installation will serve: Residence* Apartment House I-] Commercial Commercial ❑ Trailer Court F] Motel ❑ /Other F]Number of living units: J------ Number of bedrooms __7 .. Number of baths _3___ Lot size _ __ftr�/� ---------------------------------- Water Supply. Public system El Community system E] Private M Depth to Water Table 0-_ 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: YesP0 No [] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �1 Septic Tank: Distance from nearest well---J.._t)__-----Dist ,chef, foundation-_-1-0__.___.__.Md erial__________._____________�__________________ No. of compartments---�_.__.._______.__Siz`e_grr_�.�_ --- Liquid depths__ Capacity..._A�___�' �i —� ,sem � �T--'------- - Dispo I Field: Distance from nearest well__47P-------Distance from founclation___.f.4---------Distance to nearest lotG_na____ •______ Number of lines--3____________________________Length of each line- A---------------.Width of trench----?-4--- -------------------- Type of filter materia4W__-_Depth of filter material---,!,F7----------Total length___,'Z__q---________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.__.-.Distance to nearest lot line----------------- El _ ______ _.____- ❑ Number of pits----------------------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------------------------------------------ ElDistance to nearest lot line------------------------------ff--------------- ---------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-----------------------�----------------i---- 1 --------------------------------------------------•---•- ---------------------------------------------------- ' 1 -------------------------------------------------------------------------------------------------------- 1 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------------------------------------------(Owner and/or Contractor)S ` 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 - REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------- BUILDING PERMIT ISSUED--------------------------------------------------------t-------------------------------------------- DATE A. Alterationsand/or recommendations-------- -------------------------------------------------------------------------- ----------------•-•------••------------------------------------------------ ----------------------------------------------------•------------------------------------•--------------------------------------------------------------------------------•----- ------------------------------------- - --------------------------------------- ----------------------------------------------------------------------------------------------------------------------------•---------------------- -------------------------------- --- --- - ----------------•-------------- -- ----- FINAL INSPECTION BY:----- ---------------------------- Date_.. ' Z,- 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 . Revisea 1.57 F.RCO.