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APPLICATION F � '•. v2 � �•. ^' ' ► _. OR SANITATION PERMIT hermit No. ------------ A --- � (Complete in Duplicate) Date issued .______ 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 OCATION._�Q 0' , , 444 IV r- ------ -- Owner's Name_- --- ------------------------------------------- ----- --------------------- G -------------- ---------- Phone------ Address-------/ ---�� ----Aruut------ Contractor's Name a r.s -- --------------------------------------------------------------- Phone-- ----------- - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of livingunits: __ ❑ Other ❑ .�_ Number of bedrooms , Number of baths __ Lot size _ Water Supply: Public system Community system Private De Depth to Water Table Y Y ❑ ❑ p eft. �. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No . 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----------------- No. of compartments-------------------------Size-------•------------------------Liquid depth_ Material --- --CaPautY ------- � Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-________________ 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--o0-Ar-A—e___Distance from ou dation___'A. .___.Distance to nearest.lot line__�*-�--_ e � Number of pits------- --•---- ----Lining material_ J_ -----_--"-Size: Diameter-----a�,�--__-------Depth------20--------------------- Cesspool: Distance from nearest well-----------------Distance .from foundation--------------------Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth---- -----------------------------------------------Li Liquid Capacity 9 ----------------------------gals. Privy: Distance from nearest well-________________-________-__.___._____-___._.-Distance from nearest buifdin g------------------------------------------ ❑ Distance to nearest lot Fine------------------------------ -------------- ------------ - 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. r „ - f I ------------------- r Contract 13 :By:_ ' -------------------------------------------------------- ----------------------------- - - -- - ------ Title6%4i----- ' (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 -- ------------------------------------------------------------------------------- - -----------=--------------------------------------- EVIEWED BY---------------------------------- ----------------------------------------------------------------------- ------ DATE---- BUILDING PERMIT ISSUED--- ---- ---- ----------------------------------------------------------------------------- DATE------- ------------------------- A terations and/or recommendations:--------------------- --------------------•------- ------------------------------------------------ ------ ----------------------------------- -- ------------------------ FINAL INSPECTION BY:...... -__------_----- �- -- I Date = ,__._ !- ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100