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APPLICATION FOR SANITATION PERMIT Permit No. .. - _--f (Complete in Duplicate) Date issuedV2sndescribecl. -- Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT N__ �z v__a_-- __.<_ ---_ k ------------------------=-------------- Owner's Name-----------=------------------------'- _-----------------------. - t Phone ""�� Address-----------•------ r. -- . ------------------------------------ ---------P-'-'-----^-- f --------- Contractor's ------ r. Contractor's Name =_ - -•- -- ---- - -----------------------------•----------------------------•-------- Phone------U --7.__._7 Installation will serve: Residence 9partrnent House ❑ Commercial '❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: k_ Number of bedrooms _..�-._ Number of baths ._/__ Lot sizeII __��-0_�________________________ Water Supply: Pdblic system '2rCpnmunity"system ❑ Private ❑ Depth to Water Table .x41 ft. r Character of soil +o a depth of 3 feet: I Sand ❑ Gravel p Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0-1 pan ❑ ;' 9� Previous Application Made: Yes ❑ No 2---'New Construction: e ❑ o TYPE OF INSTALLATION AND SPECIFICATIONS: # Y (No septic tank or cesspool permitted if public sewer is available withi 200 feet.) Septic T nk: Distance from nearest well----- from fpundafion____/_�_______--MaMteri _ !ti-[./ No, of compartments_________. - _-_-._-_-Size __._K ___ __Liquid depth__.%J1___r.._--------Capacity-----6-_� � Disposa Field: Distance from nearest well______-.-_Distance from foundation___. --------Distance to nearest lot line--- __NemNumber ber of lines-------------/-_ _ ___--- ---Length of each line-------- r� -----E/-----Width of trench----0�=--y------------ --- Type of filter materialt �-- ---Depth of filter material------ -_- Total length_- .__v�--_----- - - - Seepag Pit: Distance to nearest well------�'-_______Distance fro fou ation______ ____ _____Distance to nearest lo! fine----/�__-__ Number of pits.--=.___ :__'"'_____Lining material�__C_ Size: Diameter___13�_-..-____.Depth..-_-_ -- ------------ Cesspook Distance fi-om nearest-well_ --------------Distance from foundation__.-________-______Lining material______.-________________________-_ ❑ 1. Size: Diameter -------------------- ---------------Depth----- -�-.----------------•--------------- ` ---Liquid Capacity----------------------------gals. Privy: Distance from nearest well________________{_'__________-______-____- Distance from nearest building------------.---------------------- ----- ,. ❑ -Distance to nearest lot-line'"'-----------------------------------T Remodeling and/or repairing (describe):_______''`-___ _-_ _- _-----------------•_ s - ----------_--------_........._-------_-----------------------------------------------------------_____._.-__--_.__________ _____________-__.-___ - __---------------------------------------------------------------------------__----_---------.----------------------------------------.--------------------------------------------___________-____-._____________________-------------------------- -----I----------------- f € ----------•-------------------------------•-----••-:------•----------------- ------------- I hereby certify that I havwprepared this'applica+ion 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]-----.......... --____--iF f ------ _r and/or Contractor) BY�------ T = -------------------------------- --=--------------------(Title)---- ------ ---- �� (Plot plan, showing size of to+;•location of:system in'rela+ion to wells, buildings, etc., can be placed on reverse side). -4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ .-_ .. T_ ' - ----------- - -----------------------'-----`------• ---------- DATE r REVIEWED BY---------------- ----------------------------------------- DATE__ BUILDING PERMIT ISSUED---`----------------"I :' {------•--- ------------------ •----- 1--------------------- DATE... ,-_ Alterations and/or.recommendations--------------- -• - -------------------- 1 e E , ----------------------------- -------- - = =i ---- -- f f - . f - •----•--------•------------------------- ------------------------------------------------------------------------------------------------------------- _ k------------- - -------------- ------- - FINAL INSPECTION-BY--------------------- ------------f =-- - = .--- --------- ~Date-----------•---"-"•--�-• -._f----------------- -- -- - �� -r SAN JOAQUIN LOCAL HEALTH DISTRICT 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 : Revised W-2100