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5� APPLICATION FOR SANITATION PERMIT b Permit No. v (� (Complete in Duplicate) j (?� Date issue -Y_Yt------- 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 ADDRESSAND`L AT N_______-- _ ' r --------------- -------- ---- -: Owner's Name__ - --- ------ --/ ----- -------------------- --------_ Phone---- ------41511t / - Address------ � ------- - d ---- -----£------ -------------------------------------- ------------------------------ - ---- --- - - 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 ___________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado b Hardpan ❑-- Previous Application Made: Yes ❑ NoNew Construction: Yes No E] TYPE= OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well Distance from foundation,,�f./ Mat�eri I____ __ ---------- No. of compartments__ _.._____.___Size__�_Ex01x_V__tquid depth->�-- -9-----_-Capacity------ Di; _____ _ Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-?r___________ Number of lines_________________ _ Length of each line------- _ Width of trench_________ ___-_________-� x Type of filter material-_, _ __ Depth of filter material------ -___'_.___Total length--------`5�>------------------------ Seepage Pit: Distance to nearest well_ -------Distance fr fou ation '`�_J.:__.Distnce to nearest lot line_-_._ _..t Number of pits____ _ __________Lining material _�__I_ Size: Diameter--_,Y__-_______--___Depth_�,.. C�_p--________._._. Cesspool: Distance from nearest well-------------- Distance from foundation--------------------Lining material---_--_____- __--__.._____________ Size: Diameter------------------.------------------De th---------------------------------------------------Li uid Caaci._ F' "`Distance from nearest well_-'_________T___.____ -^ rivy:} - Distance from nearest building------------------------------------------ F1 Distance to nearest lot line---------------------------------------------------------------------------------------------- -------- ------------ ------------------ Remodeling and/or repairing (describe)= -----------•------------------•----------------------------------------------------------------= ---------------------------------------------------------------•---------------------•----.--.---------------.---------------------------------------------------_----------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St ws, an rules and regul on of the San Joaquin Local Health District. ^+� (Signed) Owner d Contractor By:---- t (a f --- ---'-----------------------------_---------------------------------------------ITitle --------- --------t; (Piot plan, showing si f lot, location of system in relation to wells, buildings, etc., can be p d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__________________ _ ___, _ +--------- -- --------------------------------------- DATE REVIEWEDBY--------------------------------------- ---------------- ,-►�----- ---------- -------------------------------------- DATE-- ------------------------------------------------------- a BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations-------------=-=------- =---,----------------------------------------------------------------------------------------------------------------------- -------------------------- ------------------- ---------- ------------------------ ---------- -------------------------------------------------------------------------------------- ------------ -- + FINAL. INSPECTION BY--------------- ------_____-- .- .- Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California, Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100