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APPLICATION FOR SANITATION PERMIT Permit No. .. _ . ... _ -� r (Complete in Duplicate) Date Issued ------ __-_ r_ �' i Application is hereby made to the San Joaquin Local . ealth District for a permit to construct and instal] the work herein described. This application is made in compliance ith County O dinance No. 549. JOB ADDRESS AND LOCATION.... _ Owner's Name . -✓c�-lr�.r /.I - Phone '�=�`� --------------- Address--------------------------------------••-•-----• 2` � ' -------------------------•-•--------------------- --------------------------------------------- Contractor's Name-----------------------_--- -- - -----------------------------------------••----------------------- Phone-------f --------- Installation will serve: Residence C, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: __L___ Number of bedrooms ____Number of baths __L___ Lot size ____ _p_^__ ------! v_r __.__..__.__ Water Supply: Public system E4 Community system ❑ Private ❑ Depth to Water Table ,,4ft. 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 ❑ No ❑�L��ztmQJ7 ar �,-y,,� TYPE OF: INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W fPk: Distance from nearest well_______________Distance from foundation__________________.MaterialSr I h I No. of compartments_.._____________ _____Size_____---______-_______ __Liquid de th_____--__-.-__._.._______-Capacity Dis osal Field: Distance from nearest well_________________Distance from foundation-------------------.Distance to nearest lot line--_-_______.__--- v ` } gin Number of lines-----------------------------------Length of each line------------------------•----.Width of trench----------------- ------ - Type of filter material---------- Depth of filter material---------------------._Total length____________________.________________.__ Seepage Pit: Distance to nearest well_JADA_Q7---Distance fr�T',fgjundation__/_�_�-/-_-._..Distance to nearest lot Number of pits.____._/_.__________Lining mate ria l_e� dufJ___--Size: Diamete r_1-711.3.1l.........Depth .- -,1-.-�__..--_._._-.- (� 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):--------- -------------------------------------------------------------------------------------- ----------------------------------------------•--------- ---------------------------------------•-------•---•--------.•--------------------------------------------•--------------------------------------- -------------------------------------- -------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I-------- 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 an regulations of the Sn Joaquin Local Health District. (Signed)--_---••----••-----------=-------------- -----�-- - e ,_— Contractor} C BY: -------------------- � = = ----- , _ `<Title}. f_ Yl_ �_ (Plot plan, showing size of lot, location of system�irs celafion to wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -----------•--------------- DATE---------, ,;� �� 5 REVIEWEDBY-------------------------------------------------------------------------------------------- --------------------------------- DATE BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------• DATE-------------------------- Alterations and/or recommendations:-------------------------------------------- - -------•- ----------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------•------------------------------------------- - ----------------------------------------------------------•-----------•----- ----------•---------•-•----•---------------------------•------------------------------------------------------------------------------------------------------------------------------- ---------------------------- -------- ---------------- --------------- ---------------------------------------- -------- ------ ----------------.------------------------------------------------- --------------------------------------------------------- � 'i 0 FINAL INSPECTION 13Y:. ✓� G''1 Date 12 �7 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 E5-9-2M 10-s2 Revised W-2100