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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 9 Date Issued ---•�--.--�-- Applica*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 Ordinance No. 549. JOB ADDRESS AND LOCATION_____ _ A____ �` Owner's Name---------------------t--b � ... __l- -iE -------------- -----. Phone-------------------------------- ----- ------------------- Address-----------------------------------------------------•-•------------•----------•-- - ^ _ Contractor's Name-------------------- -- - �-�"�6/`,a,�.---�------------------- --- •-- --------- •----------- Phone----------------------------------- Installation will serve: Residencte ❑ Apartment House [-] Commercial ❑ Trailer Court E] Motel E] Other ,Y Number of living units: _I______ Number of bedrooms ___1___ Number of baths _1___ Lot size ........ r�____________________ Water .Supply: Public system ❑ Community system ❑ Private epth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ el ❑ Sandy Loam ay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes [�fe ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep is Tank: Distance from nearest well_ �j_-Distance from fo'u"ndlatiion__-*�___�--------Material-__---___ ____V- 513 ___ ___ ------- .T' ______ No. of compartments_____._d'��_�_/._.-.Size.___ �5-Liquid de th__-._ --_____.Cap acity______ Disposal Field: Distance from nearest well_aV istance from foundation __-Distance to nearest lot line__-- plumber of lines____________ -_ Length of each line___trr _��-.....Width of french-.___ �r Type of filter material __/_depth of filter material__ ./�____-_-_Total length_______ _f ___`%________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation__________________Distance to nearest lot line----------- F 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 fromtnearest well---------------_........._.__r_------ -------Distance from nearest building--------------------___________________- ❑ Distance to nearest lot line-------- ---- ---------- ------------------------------------------------------------------------------•------------------------------------ Remodeling and/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, State laws, and rules and regulations of the San Joaquin Local Health District. ��"`-- {Owner and/or Contractor) (Signed) - .a '" -'----------- y• (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 --- - ------ -------•-------------------------- ------ DATE---------- REVIEWEDBY------------------------------------------------------------------ ----------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------- ------------------------------------------------------------------- DATE.-------------------------------------• - - ----------------- Alterations and/or recommendations---------------- ----------------------------------------------------------------------------------------------------•- - ------------------------------- ------------------------------------------------------------------------- -------------------------------------------------------------------------------------------•----------------------------------------------------- ---------------------------------------------------------------------I--------- --------- -------------- -------•---------------------- ------- -•- ----•- f FINAL_ INSPECTION BY:.. 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 E5-1-2 145446 AT WOO 12-54