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APPLICATION FOR SANITATION PERMIT Permit No."f.7,51f `� (complete in Duplicate)(Comp p ) bate I ssued//-_,9� Applica{ion is hereby made to the SanJoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance ith County Ordinance,No. 549 �OCA ADDRESS AN � •-- - E. -`------- Phone-----------------------•------------ Owner's Name Address----------- � -- - .........------•-- ----------------- Contractor's ------ - Contractor's Name--- r.?.,-- ------ ----- --- -------------------------- - -------- ----------------- •---•--- Phone............ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _r____ Number of bedrooms AL.,. Number of baths -1-__- Lot size __ __ ._' ______ __________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table$ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El 5-Sandy-Loaff❑"Clay Loam ❑ Clay f '" dobe ❑ Hardpan ❑ Previous Application Made: Yes 0 No A^New Construction: Yes �°It ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from foundation----AV____---.Matgrial___ _ __ ________ _ _______ No. of compartments--------'sL--------------$ize --�--�-�-------Liquid depth----�-�_- --,---�--.Capacity---- �-�----- Disposal Field: Distance from nearest welle7lk--`"' Distance from foundation-_____4__9--------Distance to nearest lot line____4n.9______ Number of lines------------- °.__i..- .__ _Length of each line-----.'-0---r------------Width of trench___- _�_'_______________� Type of filter material---�_Z.____ /(_Depth of filter material-__._ _-I_4P. -___Total length------.�E�_�-____________________ .I - - -' Seepage Pit: Distance to nearest well_�____Distance from f undation___-4� .__..Distance to nearest lot line___ *___.__ [�..�..�- Number of pits----------------------Lining material_ - -._.------ -----.Deptn____ --------------------------- Cesspool: '-------------------- -- { size: Diameter- -- --__-�-- . r Cesspool: Distance from nearest well-----------------Distance from foundation°"""__A_-_.___.Lining materialf_________-______________________. ❑ Size: Diameter------------ ------------ -----------Depth----:-------------------------- Liquid Capacity gals. Privy: Distance from nearest;well------------------_------------------------------Distance from nearest building.____.-______._______ i ❑ Distance to nearest lot,line____________________________ ------------------------------------ a Remodeling and/or repairing (describe)---------------- ------ -------------- --•-•-------------------------------------------- = ----------------------------------------------------•---------------------- -•----------•------------------------------•----------...----------•--------- - ---------•---------------------------•----------•-•-.----- ------------------------------------------------------------------------------------------------------•----••--------------------------------------••------------••----------------------•-•-----`---------•---------._._..- I herebycertify that I have-prepared thi ap" lica�ioti and that.the work will-be done in accordance with San Joaquin County ' Y � PP � 9 tY ordinances, State laws, and rules and{re9ulati6'i of the San Joaquin Local Health District. , (Signed)------- 1 "t. !` �. { Contractor) B ----------- (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---- i3U[LDING PERMIT ISSUED. -- --- -------- ----- DATE Alterations and/or recommendetions--------------- �-----------------------------------------------------------•------•-------------------------•--- --- --------------- ---------------------------------------•---------------------------- --------- ---------- --------------------------------------------------- ---------------------------------------------------------•-------•-------•---• ------------------------------------------ + FINAL INSPECTION -BY----------------- ------ Date------------------: SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street e14 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100