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• �5 APPLICATION FOR SANITATION PERMIT Permit No.b (Complete in Duplicate) V Date Issued _ � _-- 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 Ori ante No. 549. JOB ADDRESS A14D OCATION..3, _ f---------------_ Owner's Name----- ---- ----------- ---- - -----— ------------------- _ Phone = Address-------- ----------------------------------------------- - ---- ... Contractor's Name ....... •-•---------•--- ---------------------------------------------------------------------------------------------------------- Phone--------------- ------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote ❑ Oth r I--- dd 1 Number of Irving units: _a[____ Number of bedrooms .- . Number of baths -_f____ Lot size xI_-�_ __ �____-..__ Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Ly" New Construction: Yes RNo ❑ Gw TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public fewer is available within 200 feet.) Distance from un ton__ ________________Materi If___ __ _________ ______________- Septic ank: Distance from nearest well__ , I No. of compartments____________ _ ______ _Size._c�__�_S __ __ ____Liquid depth------------ - --__--Capacity___ __0_01 Dispos Field: Distance from nearest well__f-(!_____.Distance from foundation___jj��___Distance to nearest I t lffi''f�?,f_ _.._:i: Number of lines___________ __ _ _ __________ Length of each line______-____i__ Width of trench______Z`f' Type of filter materiA /Iwtb p i e th of filter material------- --__-•---Total length----------(_---0 --------------- Seepage pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__:____-_________ ❑ Number of pits----------------------Lining material----.------------------Size: Diameter------------------------Depth-----_--------------_------------ 1 Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material_____________________________________. ❑ Size: Diameter-------------------------------------Depth------------------------------------------- ------Liquid Capacity---------------------------99LS. r Privy: Distance from nearest well----.--------------------------------------------Distance from nearest building--------..__._____________________---__.-. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------____-------------------------------------------------------------- ----------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- -----------'-------------------------------------------------------------------------------------------------------------- ------------------..•---•-------------------------------------------- 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' egulations of the San Joaquin Local Health District. { (Signed)--)- ---- -- -----------------------------------------------------------------------------------------(Owner and/or Contractor) By:........-•..........-......------------------------------------------•--------------------------------------------------------------(Title)----------------------------------------------------------: (Plot plan, showing 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-----_---------- ------------------------------------------------------------------------------ DATE----------e--------------------------------------------- Alterations and/or recommend&+ions--------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------•---------.--------------------------------------------------------------------------------------------•--•-------------------•--•------------------------------------------- ----------------------- f1 -rte FINAL INSPECTION BY:--------W11Sf�------------------------------- Date--------- l /t'r-- --------------------- --------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M 8-51 Revised W-2100