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APPLICATION FOR SANITATION PERMIT Permit No.L-10 . (Complete in Duplicate) (/ Date Issued __e-_-1--_`� 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. JOB ADDRESS AND LOCATIO - --------- .__ __ T ---------, ------------- Owner's Name -= s _ .'� ---- -------------------------------------- Phone v . is �; f Address-------------------------------- - -------------- 11 Contractor's Name Lia----I•=----------------------------------------------------------------------- ------ Phone---------------------------- ------------------- - - Installation will serve: Residence ❑ Apartment House ❑ Commercial xTrailer Court ❑ KIplal, ❑ Other ❑ Number of living units: __Z__ Number of bedrooms ________ Number of baths ___-___- 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 ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob, Hardpan ❑ Previous Application Made: Yes ❑ N , New Construction: Yes`O`No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SsFt.c TapkC�--� Mstance from nearest well_________________Distance from foundation--------------------Material---__________________-____-____________________- `�_ ,❑ No. of compartments------------- ----------Size--------------------------------Liquid depth--------------------------Capacity----------•----------- �D�isLp[osa FieldA` Distance from nearest wellf�APf�]Distance from feundation___f�____ ._-Distance to nearest lot lin !- r Number of lines_____________ --------_ Length of each line_--------_ \ f f_f_.Width of trench ___4- - ---------- Type e of filter material---- - !Depth of filter material-____- Total length-------•__-- -- I� .�%x -/ f Se ag it: Distance to nearest w/�II___________________Distance from $uf�dation__� __ ____.Distan e to nearest lot line___ f___ Number of pits--------__f Lining material- -- --4 _Size: Qiameter___ 'x__ ---_--Depth-------�-p------------------- Cesspool: Distance from nearest well__--------------Distance from m foundation---------- -------- Lining material-------------------------------------- El Size: Diameter-_—.Y-_.:.._-------------------Depth-. = ----------------------- ----------------Liquid Capacity- = ` gals. Privy: Distance from nearest well _______________________----------------- -------Distance from nearest building----------------------------------------- El _--- ____________-__❑ 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 ruled and regulations of the San Joaquin Local Health District, �____gwwvne(Sig f�-- _- •--•._..: ---- ---"------- ---------------- - ------------------------ -- -------------------------- (Owner and/or Contractor) By:----•------------------------------•------------------------------- ------------------ -----------------------------------------(Title)---------------------------------------------------------------- (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______ -!REVIEWED BY---------------------------------------------------------------------------- -------- ---------------------------------- DATE------------------------`--- --------- -- - -- -- ----------- DIN PERMIT iSSUED--------------- -------------------------------------------------------------------------------------- DATE---- Alterations and/or recommendations:- ------------------------------------------------------------------------------------------------------------------------------------•-------------------•-------•--------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------- FINAL INSPECTION BY:---M---------------- -------------------------- 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