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APPLICATION FOR SANITATION PERMIT Permit No. sem__._2__z___JP (Complete in Duplicate) Date Issued _`_°_ --5/ Application 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 No. 549. . UU JOB ADDRESS AND Owner's Name__,.----- Phone Address ------------------------------ ----------------------------------------------------------------------------------------------------------------------=-------------------•- Contractor's Name ---------------_------------------------------------------------------- - ------------------------ Phone--------------- ------------------ Installation will serve: Residence ElApartment House E] Commerci 1 T ailel Court ❑ Motel ❑ Other ❑ Number of living units: _ Number of bedrooms -- Number o ---/--- Lot size Water Supply: Publics stem Community system ❑ Private Depth to Water Table #t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe V� Hardpan ❑ Previous Application Made: Yes ❑ No []r New Construction: Yes No ❑ TYPE R OF,INSTALL_ATIO_ NAND SPECIFICATIONS: ._ r No septic .._• ��.. --'Yr' ��^'r- .-..-�y+e�_ .. -.Yv. ti_.,�y J..�'ala� a' '+w� i��}y --s.•' ( p tank�or cesspool permi+ted if pu he sewer is avelleble within 2pp {eet) Septic Tank: Distance from nearest well. __ ._1.--_Distanc fr foun n___ ___ w No, of compartments___._____'�t ________size___ _A-�____Li Liquid de th-_--- t � l, / q � p ---------_CapacitY Disposal Field: Distance from nearest well--_-"`E� __.Distance from foundation---- ------------Distance to nearest lot Number of lines__________I----------------------Length of each line_ x g !F 5 l.� --------Width of'trench-----�''-- - ------------------ -Type of filter material-------------------------Depth of filter mater al______.---------__ ---Total length Fit: Distance to nearest well------------_----------Distance from foundation--------------------Distance to nearestlot line______-__________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------------------------Depth------------------------ Cesspool: Distance from nearest weiL--------------_Distance from foundation____--------------------Lining material-------------------- Size: Diameter--------------------------------------Depth--------------_ ----Liquid Capacity gals. lot— j Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line 4 Remodeling and/or repairing (describe)----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -{t - ----------------------------------•-----------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------- hereby certify that I have prepared this application and that the w rk will be done in accordance with San Joaquin County ordinances, State laws, ules and re ns of the San Joaq4Lalfh District.Si ned ��C��__ -----g )---- ---- ------ --- ----- ------®Wrier and/or Contract Y ------- ------- ------="------ ------ --- -_ -- ___--- -• ---=-(Title)__•'-n= --=----`==` -` ---------` -------=---" --- (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-------- I--- ----------------- ' - DATE------------------ x jr REVIEWED BY - - ----------- -------------- DATE-------` { -- - -------- ---- -- - ----------------------- --- -- BUILDING PERMIT ISSUED--------------------------------------- j AlterationsDATE---------- ------------------------------------------------ .and/or recommendations_______________________ , ----------------------------- ------------------------------- ------------------------------------------------- ------------------------------------------------------------------------------------------------------------- J FINAL INSPECTION BY:---------f - 9 i� --------------- Date----------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street # Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100