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APPLICATION FOR SANITATION PERMIT Permit No. 4-57-2.. (Complete in Duplicate) I—A Date Issued ---_ __�_A-:2 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 rdinance No. 549. JOB ADDRESS '(PD LOCATI ___�` Owner's Name__. _. _____ " __ Phone,2__'"_ - --------- -- -------- Address__- ...____1__ ------ ----- --- -----------' ------• Contractor's Name-- --------------------------- --------••------------------------------------------------------------------------------• • ----------------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑tt Commercial E] Trailer Court C] MotelE] Othr ❑ Number of-living units: - [Community system -E] ,Private E] Depth to Water Table ________ ft. ---------------------------- Character of soil to a depth of 3 feet:. Sand P Gravel ❑ Sandy Loam Clay Loam E] Clay ❑ Adobe Me/Hardpan ❑N Previous Application Made: Yes ❑ No New Construction: Yes o ❑ O TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public'sewer is available within 200 feet) Septi yank: Distance from nearest well ____,_ istar�e0fro found ion---- _ .# PMat ri`I ---------• - ----•---- No. of compartments__-:- -- ,f---- __-- ze ? _ _- --Liquid depth--__- --_---------Capacity--- 109 Dispo I Field: Distance from nearest well _ istance from foundation____.-.-Distance to nearest I t li Number of lines-__________ _ ength of each line-------------- Width of trench_______ ____ Typei- `-�' - A p y� T e of filter materia -�-De th of filter material_______ __ _______Total length____ -_---_-_------_---- Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------------Distance to nearest lot line----------------- El _____-.- -_-_❑ Number of pits-_------------------Lining material-----------------------Size: Diameter------------------------Depth-__--_--------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------- Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------•------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line-------------------------------------------------- Remodeling and/or repairing (describe}-------------------------------------------------------------.-------------------- ----------------------------------------------------- -------------------------------------------------------------------•------- -------------------------------------------------------- -------------------------------------------------------------------- -----------------------•------------------------•-------------••----------------------------------------------------------••-------------•-------------- hereby certif. that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St , s, and rules and�gulations of the San Joaquin Local Health District. {Signed) ------ ��' - ..... Y st (Owner and/or Contractors - - - - - - - - rile -----------( )----------------------------------------------------- ---------- (Plot plan, howi g 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---------------------------- - - ---------------------------------------------------------------- ---- ------ DATE------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------- ----I----- DATE ----- Alterations and/or recommendations------- ----------------------------------------------------------------•-------------__--------------------------�Z ---------------••------------------------••------------------------•-------------------------•--------------------------------------------------------------------------------------------.. ---- ---------------------------------------------•- ----------------------------------------------------------•-------------------------------------------------- FINAL INSPECTION BY:----- = Date. f� € , ------- v SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfraet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES .9-2M B-51 Revised W-2100