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A APPLICATION FOR SANITATION PERMIT Permit No. ._.�... (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 Ordinances No. 549. JOB ADDRESS AND L CATION � X4 ------ � -- _ Owner's Name----------- -�� --- _!f Phone Address 1 - - •• f� i - - ------- --- Contractor's Name - ----------- --- Phone Installation will serve: Residence ❑ Apartm of House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Otherxt4f4-Lo' Number of living units: __- `Number of bedrooms _ _ Number of baths __ Lot size ___-,� +' �_ ...�__________________ Water Supply: Public system E] Community system El Private � I Depth to Water Table _� __ fft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes 1� No ❑ • TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if pub'c sewer is available within 200 feet.) Septi Tank: Distance from nearest well_- -Q.---Distanc from found tip 60 Material No. of compartments------X--------------Size__ r - , - (- " ' quid depth---------; --- !+ .Capacity-02--�- ?-Q---- pispasal Field: Distance from nearest welL... Q_-___Distance from foundati n�_►-_ __ ___._.Distance to nearest I�t li e„ �** Number of lines------/________________ ______ Length of each line---- _Q_f�--------Width of trench____.. _ ..... .. .._+7� Type of filter material_____ P 'm, Depth of filter material___ __-__________Total length _{T_--_ _ _f_--_____— 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_ 10.0---Distance from foundation___ 0-------Lining material__ Size: Diameter-- - --LZ- - -------------Depth-------.'3___ _ - _----------------------------Liquid-Capacity--- --C7_ -gals. Privy: Distance from nearest well-----------------------------------_-------------Distance from nearest building ❑ Distance to nearest lot line--- ------------------------- -------------------------------------- 11111�f ` Remo lin and/pr re ai i � (describe]: ---- —1�----/ a E� ��,. .St g m? _.,______________yam_ .-�_.j._Q__�_^____._.__.__.___.___ _______________________________-._.._______-_______________-_________.__._______________-_-______________-_ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. '.�A'y (Signed) °” N "'' ` s.�` #�,` .�� (Owner and/or Contractor) 1------- ----------------- 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 APPLICATIONACCEPTED BY------------------------------ --------- - ---------------------------------------------------- DATE-----------•------------------ ----- REVIEWED BY __:- R=- --1. - -- --- - DATE-------•--- ... '� r BUILDING PERMIT ISSUED �y ..;:r-_ .-h," --- ------ DATE------ ------------------------------------- Alterations and co endatio.s----- --- - --------------------------------- ------------------- -------------------------------•---------------------------•------ ----------------------- ------4--- --- - -- ----------- ------------------------------------------- ----------------------------------.... ----------------------------•-•------ 41 FINAL INSPECTION BY-------------------------- ----- - Date l 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