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APPLICATION FOR SANITATION PERMIT Permit No. �-- --------�-- `� . (Complete in Duplicate)P ) Date Iss ued 1-'S� 11 } 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 LO.C�ON----____ _____ e� _-----------�--�� --� -----�--- - - -------------------------- -- ----- -------- --------- -------✓---- Phone---'f------- ------------------•---- Owner's Name------------ -1- ------r------- --------------------------------- ,2 -------�-------------------- i G5 -e--------------------•--------•-------------------------- ----•-------•------------------------------- Address--------------------------------- ---- ' •-- - ------------------------------------------- - -------------- -- ------------- Phone---=`------------------------------ Contractor's Name---•-----------------------------------•- .. Installation will serve: Residence Apartment House ❑ Co mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ----------------- Number of living units: Wit_✓__ Nusrber'of bedrooms ______ Number of baths ___ Lot size _____- s Water Supply: Public system �munity system 'El Private ❑ Depth to Wafter Table __--____ ft. L Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam X Clay E] Adobe❑ Hardpan E] Previous Application Made: Yes ❑ No New Construction: YesX No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material ° Septic Tank: Distance from nearest well-'4 -Disfance from foundation_ ; "___________ __ Size_ '7� Liquid depth----- Capacity No. of compartments------/ -----• "----- -- --- - �is Disposal Field: Distance from nearest well_--___ -___wDistance from foundation--__/-- -----------Distance to nearest lot line____ P ----__Length of each line----�Q----------------Width of trench_!---- - ----------------- Number of lines---------/•-------------- rr Total length.______ - --------------------------- Seepage ----• J Type of filter material_____1444'---------Depth of filter material__--. _____-- } � n Seepage Pit: Distance to nearest well_____________________Distance from foundation-__________._______Distance to nearest lot line__________-.____ V , ❑ Number of pits---------- - ---•-----Lining material----------------- ---Size: Diameter-----------------------Depth-----------------------•--------- Cesspool: Distance from nearest well-----------------Distance from foundation_.__--"""_--"_____.Lining materiai__ '________t-_- - al ` Depth_-- --' ---•-•------ - --- _-----LiquidyCapacity' = ----------- Size: ------ 9 ❑ Size: Diameter---•------ ------ ---- _,. P � . _ r` �� Distance from nearest building----------------- ------- Privy: Distance from nearest well------"---------------------- ❑ ---------------------------- 1 1 E Distance to nearest lot line---------------------------------- --- - Remodeling and/or repairing (describe)______________ - ----- ' --- _-_"_ - - ------------------- ------ -------- --- --- , ------- ---•----._ -------- ---------- ------- ------------ ------------ --------- -----• --• -- — ---------------------------------------------------------•----------•---- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Owne (Signed)-------------------- ---- �--t = -.nom•' . ----------------- -------------------- Tale ( rand/or Contractor ------------------- § (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMI=NT USE ONLY I1501 15 - DATE----------------- ---------- � ""--------------- - DATE APPLICATION ACCEPTED BY REVIEWEDBY----------------------------------- - -------------------------------------------------------------- --------- --------- ------------------------- DATE-- -- ----------------------- --------- ---------------- tiBUILDING PERMIT ISSUED---- ---------------------•----------------------------- --------- ---------------------------------- -------------------------------------- Alterations and/or recommendations;_______________________ ____ --_- -------- ----------------- -------------------------------------------------------------- Date - - - --- - -- ----- -- -- . Date -- ------------------------ FINAL INSPECTION BY SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Lodi, California Manteca, California y' aS Stockton,,California .�. ES--9-2M 5.51 Revised W-2400