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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ... bed. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descri This application is mad 6�n compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------.614__Gratte-n----------------------------------------------------------------------------------------------------------1014-------------- Owner's Name------J�--�_r0ia------------------------ ---------------------------------- ------- Phone----�-�0��-----•---•---- - ----------- Address---------_-------8a P----- ---------------------------•------------------------------------------------------ t 1 Phone ---'3-3-9-x-5--------------- Contractors Name----------�� , 3- --------------------------------------------------------------------------------- - installation will serve: Residence E]• Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1____ Number of bedrooms ______2 Number of baths .__1__ Lot size ---------5.0---- ---100--------------------------• Water Supply: Public system [2 Community system ❑ Private ❑ Depth to Water Table 30--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ Previous Application Made: Yes ❑ No [5j New Construction: Yes ® 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------------------------------------------------- exiElIn No. of compartments------------------ ------Size------------------- ---- -- Liquid depth--------------------------Capacity---------------•-------� Disposal Field: Distance from nearest well_______________ Distance from foundation.-------------------Distance to nearest lot line----------------- eXlEtIng Number of lines-----------------------------------Length of each line------------------------------Width of trench---------------------------------- Type'of filter material-------------------------Depth of filter material-----------------------Total length----.------.--------------------------- -- Seepage Pit: Distance to nearest well-_.12Q-------------Distance from foundation-----10___...___Distance to nearest lot line___-_-5___.___ f] Number of pits------1-------------Lining mate rial__br1ak------Size: Diameter-------3_-------------Depth--------20____________________ Cesspool: Distance from nearest well----_------------Distance from foundation--------------------Lining material------------------------------------- -Liquid Size: Diameter----•------------------------ -------Depth--------------------•---------------------------- Liquid Capacity --------------------9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F1 Distance to nearest lot line------------------------------- ---------------------------------------------------•---------------------- Remodeling and/or repairing (describe):--------------- ----- •-------------"-------- -------------•---------------------------------------------------- -------- ----------------------------------------------------------------------------•------------------------------------•------- ---- ----------•------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- -------------------------------------------------------- (Owner and/or Contractor) ------- � ......W-------'7{ _ 1---------- ------------------ {Title) men_.- i r. - (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 f ,.. REVIEWED BY---------------------------- -------------------- DATE - ----------------------------------------------------------------------- - BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ ----------------------------------------- --------------------------------------------- DATE------------------------------------------------------------- Alferalions and/or recommendations --------------------------------------- ------------------------------------------------------------------------- ------------------------------------------ - - -- -- ----------------- - - - - - -------- --------- - -- ! y -D FINAL INSPECTION BY: 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 8-51 Revised W-2100