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APPLICATION FOR SANITATION PERMIT Permit No. .___/ (Complete in Duplicate) �j 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 application is made in compliance with County Ordinance No. 549. 4.0 y f JOB ADDRESS AND LOCATIO --� ` - C��- .c< 1 .C9. -•-------------------------------- -------- Owner's Name - •-------------- --� 1 : Phone------------------•-------------•--- Address---- '`'`'`' -- Contractor`s Name. -.'.�"" 161 �1- ,Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑`` Motel E] E]Other Number of living units: A---- Number of bedrooms _jt__ Number of baths _1____ Lot size ---[�_!�_i`-__A-_b_________________________________ Water Supply: Public system 4 Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe J Hardpan ❑ Previous Application Made: Yes ❑ NoN New Construction: Yes M, No ❑ FHA/VA: Yes ❑ Nool TYPE OF INSTALLATION AND SPECIFICATIONS: i V (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welll�' 0__.__Dista�jc from foundation__�__L'�---------- Material-__-___�.l -S,�,� 4 -----Liquid depth-----t.---------------Capacity- Disposal apacity- Q � No. of compartments-----.__K-Y__________._Size__„] �-_ Diso\sal Field: Distance from nearest well Distance from foundat-on____ p �_�� __________.Distance #o nearest to I��e S________ Number of lines____________ _______________ __ ength of each fine____ _________ Width of #rench___ ---- Type ___ T e of filter material r yp _ epth of filter material____.__ _ ___________Total length__"~,. �_____.____ Seepage Pit: Distance to nearest well-k- g,4_:_Distance fro foundag ion___ Y.t�________.bistanee to nearest lot line,______________ Number of pits----I----------------Lining materiall�"�,_�iz (Diameter----, - ---------Deptn_ -------------------- Cesspool: Distance from nearest well-----------------Distance fm foundation--------------------Lining material__.________________________,_____ ❑ Size: Diameter------------------------- ------------Depth---------------------------------------------------Liquid Capacity------------•--------- gals. Priv Distance from nearest well_________________ �- �} _ Distance from nearest building y -- ❑ Distance to nearest lot line F -- - =-------------------------------- ----------------------------------------------- Remodeling nd/or repairing (describe:- 1,� -44 ----------------------------------------------------•--------•-------- - _ ---------------------------•---------------------------------- -------------------------------------------- -- - --- - ---- ------- --- ---------------------------------------------------------------------------------------------------. ---••------------- --------------------------------- 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)------ - - i ce ` --------------------------- ---------------=----- ----------------------------------------=----------(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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ----------- DATE------ REVIEWEDBY---------------------------------- -t----- ------ ------------------------------------------------------------- DATE ------ BUILDING PERMIT ISSUED--------------------------- DATE "� ----------------- . -------------------- Alter tions and/or re rnmendation .__ ----------------- -- ---- ------------------- ----------------------- - ------- -- _---- �=--- . -'--- ----- --- -- ---- --------mss --- -----•-- --------------------------------------- •... ---.--- .i f - - - - I ��------------------------------.a�� .----- ----;- ------ -------- ------------------------------------------------------------------------------------------------------------ -._________.___-________.________._._____________------- FINAL INSPECTION BY:- ��-------------------------------- Date--- cl SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California h Manteca, California Tracy, California ES-9-2M : Revised 1.57 F.P.CO-