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I APPLICATION FOR SANITATION PERMIT-V � RPermit No. ........ (Complete in Duplicate) i _ �o Date Issu d Applica{ion is hereby made to the San Joaquin Local Health District for a it to con tr ct n all' hew "rein d. This application is made in compliance*with County Ordinance No. 549. �d / JOS ADDRESS AtD,LOCATION }- h `_- y _e _`_=_rk e qtr, f � Owner's NameiK: -- ------------------ ---------- Phone. ,. Address-•--- Contractor's Name -- - - ---------------- ------- Phone --------------- _ Installation will serve: Residence [Apartment House E] Commercial E❑ Trailer Court ❑ Mot I ❑ Other ❑ ff � Number of living units: - umber of bedrooms �_ _ Number of baths - ---. Lot size Water Supply: Public system Community system E] Private ❑ Depth t Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Lo;/No Clay Loam E] Clay E] Adobe E] Hardpan-F] Application Made: Yes E] No New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pubjic sewep,is availab a within 200 feet.) Septic nk: Distance from nearest wells -._.___--_Dista c� from foun;V�ion--------------------Mater-. l p5 t.�frrri.�'t ---- No. of compartments----- ----------- -�0-`k + T -------5i e-----. I --------Liquid r�epth---- ----- -------------Capacity , Disposal Field: Distance from nearest we ostance from foundation_I stance to nearest to lin - r------- - �� [� Number of lines---------- fir/ _ r ,/�T}'� —--- Length of each line--- _ -4 ,#__--.Width of trench----_-- ""P Type of filter mater- = epth of filter matena __ '_-_____Total length-----__---- Y Seepage Pit: Distance to nearest well----------------------Distance from foundation_- __•-----_----_.Distance to nearest lot line-_ ._-__- r 00" ❑ Number of pits Lining material Size: Diameter Depth-- --------- ------------•--- 11� Cesspool: Distance from nearest well-----------------Distance from foundation___-----------------Lining material------------------------------------- El __-----_---_----__--------_._----_❑ Size: Diameter--------------------------- ----------Depth-------------------------- -----Liquid Capacity--------- ------------------gals. Privy: Distance-from nearest well-------------------------------------------------Distance from nearest building-------------__-----___ ❑ 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)--- ----- __ _"-----�•---•-�--+�-----Wi ----------------------------------------------------- (Owner and/or Contractor) By-- --------------------------------------------------------------------------------------------------------------•----------------(Title)---•------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,-ctiW_ a plaices onreverse side). `T y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- 4 --------------------------------- =----- ----------------------------------------------- DATE-..:r-.-------• --•-- REVIEWEDBY-------------- ------------ t ------------------------------------------------------------------------------------ DATE--- -�- ------------------•------ BUILDING PERMIT ISSUED------------------------------------------------------------------------_-----------------------.. DATE-------- Alterations and/or recommendations:-------------------------------------- --------------------------------------- ------------------------------------------- ------------•------------------------- ---------------•------------------------------ ----------------- ------ 1 fNAL INSPECTION BY:. . Z,41i:z -------------------_-- Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100