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APPLICATION FOR SANITATION PERMIT Permit No. 3 d f �r (Complete in Duplicate) Date Issued l D 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. .3 �/ =r -------------r------------------------------ S. � � 1 Owner's Name---------------------------------- ------- ---------------------------------- ------ Phone----------�"—------------------ Address--------------------------------------------------- `�'-------- a' �� r T r'•L !.] tR- Contractor's Name -J -•--- Phone-------------------------- ------------------------------------------------------------------------- Installation will serve: Residence g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms _ ____ Number of baths ___L Lot size `-rax___6'p_______________________________ 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 ❑ Adobe, Hardpan ❑ Previous Application Made: YesX No ❑ New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.] F Septic Tank: Distance from nearest well__ <!Y`t__Distance from foundation......?A-------Mat�alQ__X_-_/ 1 ----------------------- K -�____ K No. of compartments _____Size..-_ tx-ex,�__-Li Liquid depth Q p ------- ------------- q P ----------Capacity o I Field: Distance from nearest wellY 'Y- Distance from foundation___,�4?_r--------Distance to nearest lot line___-��----- Number of lines____________C___________ ________Length of each line--------. _-------------Width of french---------7�1r_______�_____ Type of filter material_/--12--- ------------------Depth of filter material________/a_`____-_Total length_______________________�'--------_-___- Seepage Pit: Distance to nearest well-------_----------_---Distance from foundation-----------.--------Distance to nearest lot line--____-_-___--___ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_______________________Depth_______________________-_________ -� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________-_-_______________-_________ ❑ Size: Diameter--------------------------------------Dept}----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------- ----------- ---------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------- `1 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stade laws, and rules an..�dyy regulafions•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). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------- - ----------------------------------------------------- DATE-------------• --f -----,�---------------- REVIEWED BY----------------------------------------------------- j-�;- -------------- ------- ---------------------------------------------------------------------- DATE------ -------- -------------- ------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------- `--------------------------------------- ----------- Alterations and/or recommendations:----------------------------------------------------------------------------------------------------------•----------------------------------------------.._. -----------------------------------------•-------------------------------- -----------------------------------------------------------------------------------------------------------------------------.------------------- -------------------------------------------------•---•-------------------------------------------------------------------------------------------------------------------------------------------------••------------------- ------------------------------------------------------------------------- -------------------------------- -------•------------------------------------------------------------------------------------------------•---- FINAL INSPECTION BY:________ ______ Date-----1_ — 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 ES-9-2M B-51 Revised W-2100