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APPLICATION FOR SANITATION PERMITr`1�� Permit No. (Complete in Duplicate) e Date Issued Applica4-ion 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 Or ' anc o. 549.E i 7 �!J �- \/ ---------•--------------- JOBADDRESS 2D. OC ON..---�--�------------- � ---- - - --------�-------------• -------------------- -- ---------- --------- -- Phone------------------------------------Owners ame---------- -- ----------- .-.,� Address. -----•... = - ----------------------------------------------- -- Conactor's Name----- --------------------------------------------- Phone--------•-------------------------- stallation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] IMotel ❑ Other 1❑ Number of living units: .-__.- Number of bedrooms ----1, Number.-Of baths ___I___ Lot size ---Water Supply: Public system [+Community 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 ❑ JPrevious Application Made: Yes ❑ No [9f New Construction:- Yes,' No ❑ PE TYPE OF INSTALLATION AND SCIFICATIONS: (No septic tank or cesspool permitted if public sewer is available)within 200 feet.) Septic Tank: Distance from nearest wel4------------- ---Distance from foundation--------------------Material------------------------- --------------------------------- ❑ No. of compartments--------------=- - -----Size-----•--•-----------------------Liquid depth-------------------------.Capacity------------ Disposal Field: Distance .from"earest weli.................Distance from foundation------------------- to nearest lot line__._____._...___. ❑ YP Length of each line-----------------------------Width of trench-------------------------------•--- TNumber ebof filter mat 4rial_--___ ...____f De th of filter material_____-----------------Total length__________________-----------c Seepage Pit: Distance to nearest well--_- :_.-_-_ istance from :foundation.__ _ istance to nearest lot line-- Seepage Pit: Number of pits----- -- ------ -----Linin`g ]afterial------------- -------.Size. Diameter-- -- ----Depth .5 '^"Distance from fordation.�AQ n. "-Lining material____ -- Cesspolal: � Distance from nearer well__-._____ , Size: Diameter----�------?S,_°�------ -- P - _Liquid Capacity A -- als. Privy: Distance from nearest wel!---------------------------------------- --------Distance from nearest building__.___ __--___.__-__--------.------------. ❑ Distance to nearest lot line ----- ----------------=--•--------------- - -------------------------------------------- -- Remodeling and/or repairing (describe):__ - �-- ti/t '� ��` t �^�--•-------- ----------- I --------------------------------------------------------1------------ --------------------------------------------------------- -----•------- --- - --------------------------------------------------- -- ---------•------•----------------------- 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]..` �-�'-- -----�� ------- ---- - -- -----'------------- - ---------------------------------------------------------(Owner and/or Contractor) By:------------------------------ -•--1---------------------------------------------------------------------- -----------------(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-Wj -- ---------------------------------------- REVIEWED BY _ ----- DATE---- ----------------------------------•-------- -- ----------------------- - BUILDING PERMIT ISSUED------------------------------------------------------ ----------------------------- DATE---------- i Alterations and/or recommendations------------------------- - -------------•------------------------------- ------ ---- -------------- FINAL INSPECTION BY----------=----------- ------------------- ----- ----------------- Date-------- ----------- -------- ------•---------•---------------•---- SAN JOAQUIN LOCAL (HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street e14 North "C" Street Stockton, California t Lodi, California Manteca, California Tracy, California E9___9-2M 145446 A7WOOP 12-54