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� APPLICATION FOR SANITATION PERMIT Permit No. 'I �_ ... ` .. (Complete}in Duplicate) r Date Issued Application is hereby made to the San Joaquin Local Health D' ict for a permit to construct and 'install the work herein described. This application is made in compliance withhCounty dinan o. 549 JOB ADDRESS D LqPATION- 3 '"` . -• - -- ----------------------------------------- - --------- Owner's Name ---------- -----•--- ----- -•------ ------------ ------ Phone--- --+.------------------- Address ` - -----------------------------------------------•----- --•--------------------------------------- Contracfior's Name ------------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment use ❑� Commerci'I ❑ Trailer Court ❑ Pofel 0 Other 0 r v ?? Number of living units: --1:14umber of bedrooms _-- ,,_ Number of baths ---!•-__ Lot size ----- Q .._!�-.(�E __________________ Water Supply: Public'! system Community system E] Private ❑ Depth to Water TaTPl '�"` '#t:"'— `' "� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam El Clay E] AdobeHardpan ❑ � t Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic ta4 or cesspool permitted if ub is s$ er is available v4thin 200 feet. Septic ank: Distance from nearest wel__ ________ _ , ista fro jfoution___ '_ _____..__.Mat ril_. __.__ --- __-_ g l� No. of compartments______-___ ize -_O-X__ __-___Liquid depk___-._- ------------Ca 0 Dispos Field: Distance from Barest will _._ -.______ . Distance from foundation __ _ Distance to nearest I t I' 'y r .. .r, •��_ . _. _ �t -------------- t of lines_________ _ _ ___ ___ _Length of each line___------ -_ ._E ___-WidA of trench-.__ _ T' ` € f��., �t---------------- Type of filter mater �epth of Filter matenal________ ______._Total length____--•-L`.��►J_______________________ Seepage Pit: Distance to nearest rest well_____________________Distance from foundation`�"�'"........Distance to nearest lot line________________ ❑ p Lining material-------------- ------Size: Diameter----------------------.Depth--------------------------------- Number of its---__ _ a Y � � F Cesspool: Distance from nearest well_________________Distance from foundation________f_-_F.___Lining material__.__-._______.____._________--.-.__ ❑ Sze: Diame#er Depth Liquid Capacity------------------------ gals. Privy: Distance from Larest well------------________________________________.__Distance from nearest building------ ----------------------------------- ❑ Distance to near$qst lot line___________________._--________.____-__ —Y� Remo g anr� r pairin` (d serite):-------- •-- _ - r �'�i-- ��.... sem_, -�------- '� - $i - -------- -�- •------- ----------- - ---•----------------- - ------------------------------------------------- - --- - V-------------------------------- --- ----•---------------------------------------------- --------------------------------------------------------------- I hereby certify that I have prepared this application and that the work-will-be done in-accordance witl'i San Joaquin County ordinances, State laws, and rule and regulations of the San Joaquin Local Health District. Si ned ----- ---- ' ---------------(Owner and/or Contractor) BY:--------------- -- -------•-----•---• •- -- ------------- ------------ --------------------------------------------------(Title)------------�----- ---)-- ==-'-------------------- (Plot -plan, showing size of lot, location of system in rela ' n to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ # DATE_ -. REVIEWEDBY----------------- --- --- - --- -------------------------------------------------------------------- DATE • BUILDING PERMIT ISSUED -------------------------------------------------------------------------------- DATE------ ------------ Alterations ----------Alterations and/or recommendations;:_: = ` -� - = -=--------------------------------------------------------------------------------------- •---------------•- i-•-••------------------------------------------------------------------•-•------------------------•- -•------------------------•-------------------•-- FINAL INSPECTION BY:..--- . --------------------- -------------- Date_----1 /1. Z3------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9---2M +0-52 Revised W2100