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APPLICATION FOR SANITATION PERMIT "- Permit No./�s (Complete in Duplicate) Date Issued .�x-.- -Applicahereby 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... h r I ------------ -- --`""a ---------------------------------------------------------"---------.--------------- JOB ADDRESS AND LOCATION-------------------------------- C� , I ,- � -- --- ----------------- Owner s Name________��.+.i_.___.___"""--- 5-=--- ---••----------Ir-------t -•-------•---------------------- Address----- ---------------------- ------------/`--_t�70----- *�----1-- - -------- _-_ d -t et. Phone---------------------------------- ---------------- IContractor's iName------------------------- (►Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -,j------ Number of bedrooms --./---- Number of baths -1_---_ Lot size __ 7«-- - �• Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. rdpan E]Character of soil to a depth of 3 feet: Sand El Gravel El Sandy Loam [IClay Loam ❑ Clay ❑ Adobe Previous Application Made: Yes C] No ❑-- New Construction: Yes 8 ;N, ❑ FHA/VA: Yes E3 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.! r Septic Ta k: Distance from nearest wells �k_-Distance from foundation--�A_-_-_----.-_-Material____��-- �% --- ------ ------------ ------ Na. of compartments- --------- --------- Size--- ---------------------------Liquid depth-------------------- -- Capacity_ •- Disposal Field: Distance from nearest,well___�� ---Distance from foundation___40________"__.Distance to nearest lot line___�_�_V_____-___ of lines--------- It --------- --_ Length of each line___.___------ --�f- Width of trench-- 2 -------------------------- Number Type of filter material`_-n: -----------Depth of filter material------ -9----------Total length-------Y"s ------------------------ Type --------- .- ) ! Seepage Pit: Distance to nearest well---------------------Distance from foundation-__----..--_-___.__.Distance to nearest lot line---- '�1 Depth------ --------------- --------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter"------------" --- - - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------_-____-------------"----- V' ❑ Size: Diameter--------------------------------------Depth----- ----------------------- ---------------------Liquid Capacity..--------------------------g 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 I - and ru1�s_ nd regula ions of the San Joaquin Local Health District. µ --------(Owner and/or Contractor 5i ned _ """ -- --- ---------------------------------------------------------------------------------- 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----------- '- ---1t_ 3,�w� DATE----- ------------- -- ----------------------------- REVIEWED BY--------- ---------- ----------------------- ------- --------------- DATE------------------------------------------ -------------- BUILDING PERMIT ISSUED---_______________________ _ ------ -- -- ------------ DATE and/or recommendations:----------------------------- ---------"------------------------------------------------------------------------------------------- ------------------------------------------------- --------------------------------------------------------- ------ .e _ Zs-: FINAL INSPECTION BY------------- --------------------------------- ------- Date------------------- ---------- -- -------- ------------- ---------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C' Street 130 South American Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M Povisea 1-57 F,P.CO.