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• . pQ ,L 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 Ordinance No. 549. JJ ' --'s ----I-- --------- --------------K7---------•--------------------- ------- - JOB ADDRESS AND LOCATIO ...______J^---- Owners Name------------� ,�`- } ( T -- ----------- ------- Phone YV a1_._. Address--------------- --- -----�--- •---- � --•-----••---- ------------------------- Contractor's Name----------------•5---F-=---1_11 ------------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j____ Number of bedrooms ___Z__ Number of baths ---1--- Lot size __- _. ___ __ _. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 7-_`3. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑' Adobe❑ Hardpan JE � Previous Application Made: Yes ❑ No New Construction: Yes [ErNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___�__�__--Distance from foundation-----f_P_____-Material____.__-_______ __.____----____________ ❑'' No. of compartments-----------iZ'------Size----.-_------------------------Liquid depth--------------------------Capacity------B07�. Disposal Field: Distance from nearest well......... ......Distance from foundation____ ._._..Distance to nearest lot line___1/15._______ ❑— dumber of lines---------- rLength of each line- of of trench.____y :__ r_____________ �� Depth of filter material____.._/_ _____Total length______--.__Gid------------------ Type or filter mater-al �_______________ Seepage Pit: Distance to nearest well----------------------Distance from'foundatiorn___.-_______-_____.Distance to nearest lot line___-______._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------------------_--------- Cesspool: Distance from nearest well ________________Distance from foundation----------.---------Lining material-----------------.__.__._____.____ ❑ Si7e: Diameter-------------- ,------ ----..Depth--- =Y--------------- Privy: --------Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------_---------_-_------------------ ❑ Distance to nearest lot line.----------------------------------------------------------------------------------------------------------------------------- ------------- -R--e--m---o--d-e-l-in-g and/or repairing (describe):-----------------------------------------------------•-------------------------------------- -------------•-----------•-----------------•------------ 1 -"---- ...----. 3 '-------- -3T --- --------- ----- 7 _._-----------------------------�1----L-----------�--------------- --- ------- 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. 7(Signed).. = r - ------------------------ --------------------------------------------------------------------(Owner and/or Contractor) (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------------- REVIEWEDBY------------------------- ------ ------------------- --- ------------------------ DATE BUILDINGPERMIT ISSUED------------- ------------------------------------- -------------------------------------------------- DATE-------------------------- --------------------------------- Alterationsand/or recommendations:--------------------- --------------------- --------•---------------------•-----------------------•------------------------------------------------------ ----------- -- -- FINAL INSPECTION $Y:- ---------------------- ---•---- Date 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-4-2M 10-52 Revised W-1100