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APPLICATION FOR SANITATION PERMIT Permit Nl!-6 _______. . (Complete in Duplicate) , m / Dare Issued --- -"Y ,S Applicatign'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 o. 549. JOB ADDRESS AND LOCATIO .___ - ------ ------ -- Owner's Name------- Phone__ Address---------- ----- ---=--------------•_..-------------------•-•-••---------------...------•-- -- Contractor's Name -------------- Phone�� Installation will serve: Re Apartment e ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -_ _____ Number of bedrooms _pS,�umber of baths --f--- Lot size ----- � ----- -tet_� - ---- --- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tabl ft. Character of soil to a depth f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ad"obg. ' Hardpan ❑ Previous Application Made: Yes ❑ N* New Construction: YeX No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material_____-________.__..__________-_________________. No. of compartments--------------------------Size-------------------------------_Liquid depth , -----_Capacity, Q X � q p p Y Dispose Field Distance from nearest well__R�-_.Distance from foundation___�(�____._.Distance to nearest lot line____ Number of lines -__-___-___ Length of each line____ Q Width of trench______ Type of filter material _ -----Depth of filter material-------i� `---Total. length_____ O_________________ Seepage Pit: Distance to nearest well-----------_----------Distance from foundation--------------------Distance to nearest lot line________.-______ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------------------------------------- Size: ___-_______-__________.- Size: Diameter--------------------------------------Depth----------------- ---------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildin --------------------------------------- Distance ______-________ -Distance to nearest lot line_________ -------------------------------------------- c de an or re firing describe):-- _ -_ -• *G--/ --- -- -- .J ----------------------------------------------------------------------------------------•------------------------------------------------------------------------------------•----------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a ru and re atiopt of the Sa oaq ' Local Health District. (Si ned 9 ) t�� ' caner and ntractor} 8Y� ---- --- ------ -- ----- - ------------------------------------------------------- (Plot ----------------------------------------------------(Title —T ,� -1 (Plot plan, showing size of lot, loo ti o#system.' rely+ion to wells, buildings, etc., can be pl on reverse si e). FOR DEPARTMENT USE ONLY s APPLICATION ACCEPTED BY____ _ __ ______ _ r DATE____--- !___� " --- y - - --- REVIEWEDBY--------------------------------- - -------------------------- DATE - - ------------ --- ----- ---------------- UILDING PERMIT 1551JED ------------------------------------------------------------ DATE -- - -Alterations and/or recommendations:_--__-___-_____----------------------------- ----- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------- ------------------------------------------------------------------------ -------------------- ------------------------------------------------------------------------- ---------------------- ------------------------------------ - -- FINAL INSPECTION BY:-.----____-- .__ - s' °'� Date---,//- "'- - -- ---. ........................................ SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100