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APPLICATION FOR SANITATION PERMIT Permit No. ____— ----------- (Complete in Duplicate) ,.,, ...�..�- -_-w-•�.t _. Date issued �'773 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 LOCATION p��r� -------------- -------- � �'3 =----------------•--------------------------------------------------------------- Owner's Name-------------------------------------------------- -1`----------a-r-d_ �----- - --------------------------- -- ------------- Phone-------------------------------- Address ------------------- ----•-- ---- ------ --------------------------•------------------------------...----------------------------------------------------------- Contractor's Name -------- -------------------------------------------------------------------------------------------------------------------------- ---------------- Phone---------------------------------- Installation will serve: Residence ft] Apartment House ❑ Commercial ❑ Trailer Court [] Motel' ❑ Other ❑ Number of living units: _______ Number of bedrooms _ _._ Number of baths ________ Lot size --------/__O Water Supply: Public system ❑ Community system jq Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ?r' Hardpan ❑ Previous Application Made: Yes ❑ NoA 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--------------------Material___-____._.___._______...__.______...._______. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity---------------- . } Disposal Field: Disi-ance from nearest well________________Distance from foundation--------------------Distance to nearest lot line---------.--_.___ 1 ❑ 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__-._____,____._______Distance from foundation___________________.Distance to nearest lot cine____..._____.__. � ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------ ------ Cesspool: Distance from nearest well________________Distance from foundation_______.______._...Lining materriapfi�_. -------___.___________-____-_.) i ❑ Sze. Diameter------------------ -------------------Depth--------------------- -------------------- ---- Liqu,d Capacity- - ------------------------gals. Distance from nearest b0clin '�--__- Privy: Distance from rom nearest well-----------------n0_------------------------- 9- ----- --6Z_ --- _ J�4'( Distance to nearest llot-line__'_w'""'. .-`��---------=----==L ' ----------------------•----------- --------------•--------------------------------------- f_ � Remodelingand/or repairing (describe)----------------------------------- - -•-------------._._...------------------------------------------------------------------------------------------- --•--- ---------•--..__.....-----• - --------------• P` `� `�- rc��f---- ------ ---•---------------------------•-------------------------•-----•--- •-------•---•------------------------------------•---------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- -•----------•--------------------------------------------------------------•------------------------------------------------ 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)-------- _ ____________________(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). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- ---- -- DATE Z� �s~- -- REVIEWEDBY------------------------------------------------------------------------- ----- -------------------------------------------- DATE ---------------------- BUILDINGPERMIT ISSUED------------------------------------- ------------------•--------------------------------------- DATE Alterations and/or recommendations--------------------------- -- ------- -------------------------------------------------------•----------------•----------- -•-----------------------------•--------------•-•-•------------------------------------------------- ------------------------------------------------------------•-------------------------- -------------------_---------- -------------------------------------------------------------•--------------------- ------------------------------------------------------------------------------------------ ---------------••------------------- --------------- ---- ------------•------------------- ------------------------------.-----------------------------------------------------------------------------------------------------------------------•-------------- FINAL INSPECTION BY:------- -- Date ....._ --------------------------- r , �Z 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 10-52 Revised-W-2100