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Permit No. APPLICATION FOR SANITATION PERMIT _ (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 aicatio is made� in compliance with County Ordinance No. 549, JOB ADDRESS AND L �{ OCATION --------- , Owner's Ne----N-01 ----- ---- - -- ------------------------ ----------- Phone------------------------- - ------------------------------------------------------- - --------- 01 Address.- '_Q Aoy------- Contractor's Name ------------ !lt-L.�----r----------------------------------------------------- Phone---------------------------------- ------ -------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: ___/__ Number of bedrooms -A- Number of baths Lot size _____ ___.__________ j Water Supply: Public system ❑ Community system •❑ Private Depth to Water Table Character of soil,to a depth of 3-feet:-.Sande - Gravel❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ( New Construction: Yes Rr"No ❑ I 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_____�f)_____Disfancp�from foun of on____!--_________.Ma�t.e�r,}'al-�-C_ -------6 .____ [� No. of compartments _Size________ -Li uid depth---__ b______ .___ Ca acit p g - p y- --------- Dispose. Field: Distance from nearest well___�� _�__Distance from�fou�ation_____ Distance to nearest lot line----- Q_�__. Number of lines___________,• _110_________.Length of each line________/� _____---.Width of trench______��____Y Type of filter material�/' -+ ____Depth of/filter material-------- Total length--------I_Ar --�__________________ Seepage Pit: Distance to nearest well_____________________Distance from foundation--------.___..____Distance to nearest lot line___________-____- _ _ ❑ Number of pits----------------------Lining m'ateriai_-------------_--------Size: Diameter-----------------------Depth----_-------_-------------------- Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material-______________j___gaIs __-. 1 Size: Diameter--------------------------------------De th______ Li uid Ca aci als ❑ „.,i5 w— . _.,r,,,., — �'•'"� Distance from nearest building Privy: Distance from nearest well-------- g------------------- ----- ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------- ----- Remodeling and/or repairing fdescribe)-------------------------------------------------------------------------------------•----------------------------------------------- •---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------••----•----------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- i hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe Ia s--- nd rules and regulations of the San Joaquin Local Health District. (Signed) -- ------------------------------- ---- and/or r Contractor] By--------------- --------------------- ---------------------=----------- (Title} P` ' .'---- {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 B - ----- --------------------- ----------------------------------- DATE........: --•d!f -----cr---- ----- REVIEWEDBY---------------------------------------------------------------- ------------------------------------------------------------ DATE----------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------- Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------•----------------- F1NAL INSPECTIONB ------------ 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