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r S APPLICATION FOR SANITATION PERMIT Permit No. 1 (Complete in Duplicate) Vepe Data Issued ation is h reby made to the San Joa uin Local Health Dis#riot fora eq rmit to construct and install the work herein described. pplication is made in compliance with County Ordinance No. 549. p JOB ADDRESS AND LOCATION_ _____________ ___ f r Owner's Name__.---•-------------------------- -- - -----------•- --- -- ------------------------------------ Phone------------------------------------ Address---------------------- ------------------------ ------Address---------------------- Contractor's Name--------------- ---------------------------------------- ------------------------------------------------ Phone------------------------------------ Installation ---------------------•---------- .Installation will serve: Residencc,e 3 partment House ❑ CoM .ercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of living units: "llNumber of bedrooms __ Number of Lot size ----10 _- Water Supply: Public system ❑ Community system '[] Private epth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ G vel"❑ Sandy Loam ❑ Clay Loam... Clay p Adobe� dpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: x + i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 G Septic Tank: Distance from nearest well _ _- Distance from foundation__ _� ateri L � No. of compartments_ ------Size_ �'�w_ Li Lid d t -_____-___ Ca Disposal Field: Distance from nearest well__ Distance from foundation___ ___.Dis#ante to nearest lot line--- ----- -- Number of lines___ Length of each line________ Width of trench______ �� _________ Type of filter material_ �___ Depth of filfer material____ ___Total length__________ --- - --------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- Lj 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------__________-_______-_ ❑ ..-.Distance to nearefst lot line-------------------------------------------------------------------------------------------- - Remodeling and/or repairing (describe)------------------ -------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------•------------------------------------------------------------- ------------------------------------------------ -----------------------•---------------------------•--------------------•------------------------------------------------ i - --- ------ ---- ------- -- - - ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and rules and regulations of the San Joaquin Local Health District. (Signe - (Owner and/or Contractor) By:_��- -----------(Title)------------------ -------------------------------------------- (Plot pl , sFiowing size of lot, location-of system in relation to wells, buildings, etc., can be placed on reverse side). fi F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --------------------------------------------------- DATE- - --- w _— REVIEWEDBY-------------------- ---------------------�- -------- ------------------------------------------------ - -------------- DATE _---------------•------------ ------------------------------ UILDIN PERMIT ISSUED---------------------------- - -----�------------------------------------------ ---------------- DATE----------------------•-------- -------------------------•- A teratio sand/or ecorrlmendations--------------------------------------------------- - -------------�--- -- ------------------------ ------------------------ ----------------------------•- --- --------- ------ -- - - ---------------------------------t----------------------------------------•------•-•------------------ 111 ------- ------------------ .1-------- -----------------------------------------=--------------------•------------------------------------- -------------------------------------------------------------------------------------- -----------------------------------------I-----------------------I-------------------------------------------- ------------------------------------------------------------------------ - ------------------------- ------------------------------ ---------------------------------- =----- FINAL INSPECTION BY----------------- ` -----•- - - --- -------------------- Date---------- SAN JOAQUIN LOCAL HEAQ. DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California ESS-Sse��dW 2100