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APPLICATI014 FOR SANITATION PERMIT Permit No. lComplete in Duplicate) J V Date Issued Application is hereby made to the San Joaquin Local Health District for a perm;t to construct and install the work herein described. This application is made in compliance with County Ordinance.1-1o. 549. JOB ADDRESS AND ...... ........ ........ Owner's Nome Phone... ... ............... ....................................... ..... Address----- ------- ------- ... ..........._.... .._.....,»»...__» d�. .. . Contractor's Name..............6- ..•..................._......-......._. Phone.................... Installation will serve: Residence IZ Apartment House [] Commercial E] Trailer Court 171 Motel E] OfLer ❑ Number of living units: ...---�Num,er of bedrooms umbar of baths Lot size Water Supply: Public systern F1 Community system 0 Private Depth to Water Table ft. Character of soil to a depth of 3 feet. Sand 0 Gravel E] Sandy Loam [] Clay Loam❑ Clay F71 Adobe Hardpan 0 Previous Application Made.';'Yes Fj No New Construction. Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P_�- Septic Tank- Distance from nearest well_..Z_O_Disfanco ft m .A t ;'Or depth....... __Ca acity..*.'.*.* No. of comparfmonts....-oZ. ......... p Disposal FieA: Distance irorr, nearest d rorty 20M a4lon-'10 DUce to nearest lot lir ja� Number of lines._......,... 1�,),01_ength of each line-, h of fianch._Y_2-..��.......... Type o-`Ililter material...Mlw"Depth of f1iier material........te?......Total length...._/ Seepage Pit: Distance to nearest well... ...... Disfancafrom foundation.......... __iDisfance to re6rest lot line._..-....... Cj Number of pits......................Lining material......... .....Depth....._........................,.. Cesspool: Disfance from nea-est well------- Distance from founciat*on.............._,.Lining ❑ Size: Diameter... ... ....... ..............................-Liquid Capacity......._..»»w Privy: Distance from nearest well......... ......................Distance from nearest building.... Distance to rearest lot ......____...... Remodeling and/or repairing 'idescribe)..................................<...w ..........;................. .... w._....._....w ,.». .»».. ».......»......_..........----....»..... ._.....»....... . ............... ........._.._............ ....... .... . ..... -.............................I............ ..............._..............-........................ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St-te, laws, and rules and regulati - of the San Joaquin Local Health District. (Signed)....... ................................................. Owner and/or Contractor). .......... _....------ {Piot plan, showing size of lot, location of system in relation to wells, buildings, sate., can be placed on reverse side). .......... FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY_- ---- ...... DATE... ✓ .... ... 00 REVIEWEDBY................................... DATE.___.......__.._...._._._».,,._..»............_..-,..._ BUILDING PERMIT ISSUED.`-.-.---........ DATE................. ........... Alterations and/or recommendations:_...................................... ................................................................ .............................. .................. ............... ............................................................. ....»..............»»........«....»....»....».»... s.r.......»..............I...................... ........... .......... .............................................. .................... ».....».:._._..«»...._............_ .......... ................. FINAL INSPECTION BY .-........k ....... Date..... --- --- ----- -------t7_._. ... . ......... . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amorken Street 300 We%+ O*k Sfr*oi 132 Sycamore S+roof 814 NorA "C"Street Stockton, California Lodi, California Manteca, California .7 Tracy, California ES-9-2M 8-51 Revised W-21'00