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APPLICATION FOR SANITATION PERMIT Permit No. -. ..a-./ (Complete in' Duplicate} --.... �., .. Date Issued Application 'is,,,h reby 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 Ordinanc o, 549 JOB ADDRESS AN CATION - --------- ---- wner's Name--- - -- - � ------------- r /' Address---- -- _ Phone 00 �'/ •------ •--------`-------------------•-----------• ------------------•------------------- --• ----- Contractor's Name______________ --- -------•----------•- ------ Phone --- ------------- Installation will serve: Residence f�' Apartment Ouse ❑ Commercial ❑ r Trailer Court {j ' E] Motel E] Other ❑ Number of living units: -; Number of bedrooms- Number of bathsF--/ ---- Lot size ,,�Q_,�./flp---------------------- -- -- Wafer Supply: Public.sysfem Community system ❑ Private ❑_ Depth to Water Table,�'_Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdoblaA Hardpan ❑ Previous Application Made: Yes ❑ N0 New Construction: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se r vailable within 200 feet.) y` j Septic Tank: Distance from nearest wel! , n --.__ "s�from foundation----- ---•-----•---.Material------------ ----- � No. of compartments--.- ------ ci ---- ('� Size. --------=--------Liquid depth---------- Capacity CU - Disposal Fiel 4. Distance from nearest well_________________Distance from foundation--------- _____---- Distance to nearest lot line.____-__-___---- � � i Number of lines-----------------------------------Length of each line--------- -------------------Width of trench " ( Type or filter material_______________ _ --------- ------Depth of filter material------------•--/-----Total length----------------------------------------- Seep a Pit: ' Distance to nearest well - 01 .______ istance f m •fa dation___ 01 k- to nearest lot line_-_„ Number of pits------"// Lining material li� f Size: iometer Depth------ - Cesspool:#. Distance from nearest well_______________ Distance from foundation------_..____---__-Lii,ing material-_-______---____-__._______ ----- E ❑ Size: Diameter Depth ------------------- - Liquid CapacitY---------------------------gals. Privy: Distance from nearest well__--__.-___.--.___-_____-._-_. ---------Distance from nearest buildin ❑ Distance to nearest lot line--- g" Remodeling and/or repairing (describe):---------- 9 - -- ----- i ---------------- ----------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, an r s and re ions of the San Joaquin Local Health District. ' v (Signed)-------- - --- ---------- --------------------- --- (Owner and/or Contractors ' By: ..---------- ---------------------- (Plot - (Title} f , plan, showing size of lot, 'location of syste�m relation to wells, buildings, etc., can be ed on reverse side). 11007 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------- ---------------------------------- DATE_ REVIEWED BY_ ------------------------------------- ----------------------------------------- DATE----- - ------------- BUILDING PERMIT ISSUED------------------ -------------------•------_-- -- ----------"------------------------------------------• ----------- DATE------ ----------r Alterations and/or recommendations__________________ ------------------------------- --------------------------------------------- ------------------------------------------------------ ----------------------- - --------------- -------------------------- -----•---•---•----------------- ----------------------- - *" .. --------------- ---------------------------------–----- FINAL INSPECTION BY------------------------ Date--. � ---------------- - ---�- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North ,.C,. Street Lodi, California Manteca, California 6 Tracy, California ES-9-21v1 10.52 RevisedkW-2300 1 �`a•