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APPLICATION FOR SANITATION PERMIT Permit No. .... /�... (Complete in Duplicate) Date Issued ... Mr,7 A lice+ion is hereby made to the San Joaeiuin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 519. 1?2-_.3-- JOB ADS .. . . ....... ..... � r, ... ---•- .._._...... Phone................................... Owner's Name. Address..._ -----�'�• -- - .........-- •-•-•1q•• - ---...... - Contractor's Name. -ll�L... •. .. ........ ........................ -•••.----.....--•-••-- Installation will serve: Residence$- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units:./_. Number of bedrooms __5 Number of baths __/.__ Lot size .......... ....-•-........... Wafter Supply: Public system ❑ Community system ❑ Private (Depth to Water Table e:;...OR. - Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay[IAdobe,,Hardpan❑ Previous Application Made: Yes ❑ No E!�__New Construction: Yes,& No ❑ T(PE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i. Septic Tank: ' • ance from nearest well..................Distance from foundation....................Material................................................. ❑ ---_.. -Liquid depth..............._---_--Ca aci f compartments....................•-----Siza_____..._...- - _ p --..................... Distance from foundation...��,......Distance to nearest lot line....... Disposal Field: Distance from nearest well... ._. - Width of trench......,,,�....._ Number of lines--------/.....y�-,-r._•-•--- eng#h of each line__.,_...r�-�-. ..-fes' �--......•..... Type of filter material.-- -•-... epth of filter mat 'a -_...Total length--_•----_-�,l ---.------- - Seepage Pit: Distance to nearest wall_., Distance fou dash/n_. .. .......Distance t nearest lot fine.-/fel..... � Number of pits.__/---------------Lining materia.- e�,Diameter.-.... ...Depth.....,a -.........._ 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....................................___----------•.........................•.... ---.......... 1 Remodeling and/or repairing (describe):.......----------------•----•----•----•---------------------------------------------.:..._...................... -�... ----.------•-----....-•-•----•-----.-----------------------------••----- .......--....................._....._................... ._... .................... I hereby certify that I have prepared this application and that#ire work will be dune in accordance with San Joaquin Coun 1 ordinances, State s and rules and regulations of the San Joaquin Local Health District. � oe {Signed} ---•• - .........(Owner and/or Contractor] s ........._... ...(Tiife)_....x� r - --------------- (Plot - _._.. (Plot plan, -,-owing 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.----•-• BUILDINGPERMIT ISSUED..........._...._�.. ........ ............................ DATE__..__ C._ ........... .......---..... Alterations and/or recommendations:-_-•-- .................• ................. . ........ - _. -•--•............................::.. •••-•--._....----------•.....I...._.-_......................----- -- r .............................................................................................................. FINAL INSPECTION BY:..0P ----•--- Date..........i� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amarl"n Sheet 300 Wast Oak Street 132 Sycamore Street 814 Nodh "C"Street 4 Stockton, California Lodi, California Manteca, Ca1Hemla Tracy, California E6--a task+s ATWOOD