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APPLICATION FOR SANITATION PERMIT Permit No. • ` (Complete in Duplicate) Date Issued & 1 !_�- 2/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi application is made in compliance with County Ordinance No. 549. ` JOB ADDRESS AND LOCATION..-----8--r7_1...... "-'---0-,-1- ;�___------ /----;I1------- _ k " -4- -- , Owner'sName_1•__1 _ � { ---0--- ---------------------------------------------------------------- Phone_2_�__g Address---- ..0_..1'r_-•-- o - F _� F---------------------------------------------- Contractor's Name----------------------•---------------------------------------------- ----------------------- ----- ------ Phone--------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms ___/___ Number of baths ___�_- Lot size _____7-Q--- __-- ." =-- � --- --------•---- k --- Water Supply: Public system ❑ Community system El Private URO*ISepth to Water Table 7600ft. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy team'❑ Clay Loam ❑ Clay ❑ Adobe j?0*TTardpan ❑ Previous Application Made: Yes F] No 5��ew Construction: Yes E] No � ' TYPE OF INSTALLATION AND SPECIFICATIONS: w E (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,l Septic Tank: Distance from nearest well-----------------Distance from foundation_-_________--_.__.Material-________-______________-____--_____--_-_______- }�]t No. of compartments ------------Size Liquid depth Capacity Disposal Field: Distance from nearest well__________________Distance from foundation--------------------Distance to nearest lot line____--____ _ r, SNumber of lines--------------------------- -------Length of each line------------------------------Width of trench--------------------------------- � � _Total length Type of,flter material________________________Depth of filter material_____-______-___-_ _ g � , See pa a Pit: Distance to nearest well ______Distance fr m fo dation_________ ____�___Distance to nearest lot line---- Number of pits-------t-------------Lining material, -Size: Diameter-____ --�-----__-- Depth_--,�--fJ------------------ )s Cesspool- Distance from nearest well-----------------Distance from foundation--------------------Lining materialals. I 171Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------g Privy: Distance-from nearest well------------ - ---------- -- -------- ----____._ istance from nearest building--------- --------------------------- - Distance to nearest lot line__ ------- -------------------- -- - - - Remodelind .: r repairing (describe)=-------- -- ----- --- ----- 7------------------------ - - ------------------------------------------ C ------------------------ -- �`'` - -------------- ---------- -------- ------- -----------------------•------------------------•---------------•----_------------------,-----------•----------------------------------••-------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and r s awn egulations of the San Joaquin Local Health District. 70-7- _ - - - - r {0ner�and/or+° �CContractor) [Signed(S•gned --------- - ---- - -- -- - ---- ------- - ; ; - BY:-------- - --------------------------- {Title) - �" '� F- (Plot plan, sho�f size of of, location of system in relation to wells, buildings, etc., can be p1aee on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY�.-� ----------------------------------------------------------------- ------------------ DATE-—-----_--------------------------------------------- REVIEWED BY----------------------------------- DATE-- �- BUILDING PERMIT ISSUED------------- DATE----- �,7 -------•------- --------------------------------------------------------•-- Alterations and/or recommendations:--------------------- ------------ ----------`-------------------------• _ --- . --- -- -------•------------------- ---------- ----------•----------------- ------------- ------------- ------ --------------•---------------------------------- ----- --------- ------ ----- --- ------ ------ -- - ------------------------ ---------- --r- - ' IFINAL INSPECTION BY------------ --= = "------------ - - ---------------- Date--- ----------------> - --- -• - -------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 'i Stockton, California Lodi, California Manteca, California 'Tracy, California i 1. ES-9-2M B-51 Revised W-2100