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APPLICATION FOR SANITATION PERMIT Permit No ��...��..._�I. Z ` (Complete in Duplicate) Date Issued 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 D L ATIO ....._ ,t eda---------------------------- Owner's Name------ - ----- a-------- --- -- --- ------------ --------------- - Pho - 11 ne--- --------- -- ---- Address--------- ., •---•----------1-- --•- .................. .....I---• Contractor's Name............... - - ------------------------------------------------------------------------------------------------------ Ph e....................... Installation will serve: Residence partment,House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other F]Number of living units: ---(-_- umber of bedrooms ---I Number of baths ___1... Lot size ---_.._ __.�_�a_.rC__�.�:u------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a 4ep4h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No V New Construction: Yes ( No ❑ TYPE OF INSTALLATION AND SPECIFIC TIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V� Septic Tank: Distance from nearest well_Z_d_�_Distan fro ound�n-----_!_1J______.Mate 'al_-_-_---_-------------------- 46 No. of compartments_--_--__y�___--__.Size___-�-x` x_ ._Liquid depth______'"------__-- 41-7 Capacity_-_ - Disposal Field: Distance from nearest well.-- Distance from foundation....--------Distance to nearest lot li ..... Number of lines.....1'_ ._____-_--- Length of each line_1 .1�9_"_IY-_.Width of trench__ .__� ----------------- Type of filter material--5—j'011Ck- epth of filter material----- - --�._'---Total length----- 'f Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line--------------------„ ❑ Number of pits----------------------Lining material..........,............Size: Diameter-----------------------Depth----------- --------------------- Q 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):----------------------------------------------------------- --------------------•---•-------------•-•-------------------------•-----------------•- -------•----•------------•---•--•--------------------•---------------------------•-----------•----------------•----------•------------------------•--------------------- ------------------------------------------------ --•-•-------- -----••-----...........--------------------------•----•---------•-----------------•-----------------------------------•----------•--------•---•--------••--------------•----•-----------------..--------- ----- -----------------------------------------------------------------------------------------•-------------------.7----------------•-------------••-----------•---•-------------------------------- I hereby certify that I have prepared this application 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)..-- 4:}-;,�&,. 4 . ------------ --------------------------------(Owner and/or Contractor) By:-------- ------------------------ --------------------------------------------(Title)----------------------------------------------- --------------- (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be placed on reverse side). FOR ji9PAkTMENT USE ONLY APPLICATION ACCEPTED BY-----------------------------------------------IV7 DATE "' ,,�- ----- -------------------- REVIEWEDBY------------------------------------------ -------------- --- --- ------------------------------- DATE---- BUILDING PERMIT ISSUED----------------------------------- - -- ----------------------------- DATE-----------•---- Alterationsand/or recommendations:......------------ - - --- --------------------------------------.................................--------------------------------••---------••-•------- ...............................--------------------- ................... --------------------------•------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------•-----------........ FINAL INSPECTION BY:---------- �� 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 10-52 Revised W-2100