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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued Applica+ion 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 N 549. � JOB ADDRESS AND LOCATION....` . a73 � = ------------------' ' Owner's Name------------------------------- Phone ' Address-------------------------------------------- - -------------------------------------------•-------.....--------------------------------------........ Contractor's Name------------------------"---------- yli•�-------------------------------------•-----------------------------------------------. Phone-------------------------- --------- Installation ------=Installation will server Residence Apartment House F1Commercial ❑ Trailer Court [IMotel ❑ Other E] Number of living units: _j_._._ Number of bedrooms . _ Number of baths -_- ... Lot size ----- ----------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted 'if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well_-;..............Distance from foundation-------------------Material------------------------- .---_---_.---._--_.--. ❑ No. of compartments--------------------------Size------------------_-----•-------Liquid depth----------------- --------Capacity---------------------- 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-_--.--__--_-._o-----Total length----------------------------.---__f_._,_ Seepage Pit: Distance to nearest well- f.10 from foundatio _...Distance to nearest lot - -_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---..-----.------------Depth......----------------------- .Cesspool: Distance from nearest well._7 _ S.._-__-_Distance from foundation_-_,;)D'_hV_.--.___.Lining material--__ ------------------- v j Size: Diameter.-'-- 1--�--• ------------------Depth------�a--------------.----- --- -- :------ ------Liquid Capacity- ----------------------•---gals 1' Privy. Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------._.------_. WWW��1 [� Distance to nearest lot line._ ._ -------- --------------•--------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------.---------------- ---•--------------------------------•---------•-------- --------------•-----------------.--•---•----------------- ----------------------------------------- ---------------------•-----•------• -- ------------------------------ 4 e ----------------------------------------- -----------------------••------•---------------r--------------------..-------•--•-----------•-------------------------------•---- ' ------------------------ -- -------- ---------•-----------------------------------------------------------------•--------------------------•----•- --•----- -----------------------------------------------•--- ----- I hereby certify that I have prepared this application and that the-work will be done in accordance with San Joaquin County ordinances, S�ta a s,.atvd rules and ly_,_�ZAr4 regulations of the San Joaquin Local Health District. 1 (Signed) ; __________________ ------------------------.--------(Owner and/or Contractor) B (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------' -------------------------- REVIEWED ---------------------- REVIEWED BY---------------------------------- - -- -------- ------ DATE -------- ------------- --' BUILDINGPERMIT ISSUED-------------------------------------- -- -------- ----------------------_--------'------------- DATE-----'-- ---------------------- ----- •----- Alterations and/or and/or recommendations:.____ ._. ------ ---------------------- m ti- - - - - - -----------------------------------------------------_--- ___________ _� ___ _ ____... ,f.._......_. ...._____ .1. ....•-----i- .-..-----. "-—------..----_ - -_--_•-----------------------------------------------'------.....----------------------•---------------------------...---------'----------"-"-----------------....-------------------------"---------_--------------•--------- --------------------------------------------------------------------""....----'-----""--- ----_----------------------------------------------------------------------------------------------------------•-. -------._.....-. FINAL INSPECTION BY ----- -- Date-------------------------------'------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California E 5�--9—•2M 145446 a .... 12.54