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APPLICATION FOR SANITATION PERMIT Permit.N0,3__G...�_.1---__- (Complete in Duplicate) p Date Issued�--------�-=- --------�i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i .made in compliance with Count Ordinance No. 549. 1 This applications p Y �� /�a"_�L JOB ADDRESS AND LOCATION_ �" --- Owner's Name-_...--------- -----•-- :k +--- - ---------------------------------------------- Phone---"-"�'X- `f'� I Addresses r*- -_ --------- `` •- Contractor's Name__..--.--••---------------! -i .' -------- ------- ----------------- Phone._--�F__! --4k,_ --------- Installation will serve: Residence 5' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I--__ Number of bedrooms 1--- Number of baths ---/--- Lot size ��.-- ---------------------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ - Sandy Loam e Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200� al t.) e f ` Septic Tank: Distance from nearest well- - _�_--__.Distance from ound t' n Materi - No. of compartments---- ---__-- r ------------Size-,i��6----- - - - - :quid depth_.',��-'r...........Capacitys.0-0- -- 4 -Cy_'0-__.Distance to nearest lot line_.--_ le pisposal Field: Distance from nearest well- = Q ----.Distance from o ndation__-_� _ Number of lines-_--_-_-I___----/ Length of each line-----4P------_-__.Width of trench.____-s*______..-_-._. _�--_3 Type of filter material_ ----_I ___Depth of filter material-----11------Total length----40.0- ----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-_-----_.-_---_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- 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----------------------------------------- . F-1Distance to nearest lot line------------------------------------------------------------------------------------ ------------------------- Remodelingand/or repairing (describe):--------- ------------------------------------------------------------- -----------------------------------------------------------•-------------------- --------------------------------------------------------------------------•-------------•-•---------------------------------------•- -----------------------------------------------........--------------------------------- -----------------------------------------------------------.-.---------------------------------------- ---------------------------------------------- ------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,St`a'te laws, aadd rules and regulations of the San Joaquin Local Health District. (Signed)------"'---�-�= Foflof, ----4___g 1_t-- --` -----•------------------------------------------------ �r Contractor} By. ---------------------------------- -------------------------------------------------------(Title)---1�3 r r'"' �`" ------------------------- (Plot plan,-shing size locati rof system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE- - REVIEWED BY----------------------------- ------- DATE- QS BUILDING PERMIT ISSUED--------------------- - --------- --_- ------------------------------------------- -------------- DATE---------- Alterationsand/or recommendations: --------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------= ------------- ------------------------------------------------------ ----------------------------------------------------- --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ S FINAL INSPECTION BY: ; Date-- - �ffl �'/ 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 8-51 Revised W-2100 10