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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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-comliance with County Ordinance No. 549. [ S'? - 0�3 _t Z JOB ADDRESS AND LOCAT10N-4 - ¢ �_-�,, p C)_ 9 Owner's Name----- &.----_-�; --•---------------- Phone ------------ Address 11 - ---- _ a-tA,& ------- Contractor's Name. --•--- Phone------------ Installation will serve: Residence ❑ Apartment House Z_ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms -------- Number of baths ____I__ Lot size ___ Water Supply: Public system ❑ Community system ❑ Private Ej�--Depfh to Water Table _4AD ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[K Hardpan [] Previous Application Made: Yes ❑ No LQ' New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest waft-, G a-----Distance from foundation___ ----_.Material-____ -_ � [ No. of compartments.------- ---------Size....e) R__ -- .---Liquid depth--------4_6----------Capacity----9- ¢------I ti Disposal Field: Distance from nearest weft-i?,".____D;stance from foundation___,6_6.r-..Distance to nearest lot line__. ¢Cf_� Number of lines----------- __ Length of each line______ f g -- Width of trench. ----------- a Type offilter material_.-AI..___S--Depth of filter material____---______. -Total length____;__oge. -- Seepage Pit: Distance to nearesttaTJ_----Distance from foundation____ __ _______. c '_� __Distance to nearest lot line _ _- ---- --F-I line__._Number of pits------- ------- --Lining maea_ _ e: ---.Depth------��------------ Cesspool: Distance from nearest weft-------------____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):-------------------------- ---------------------------•-------------------•---•---------•-----•--••---------------------------------------•------- ------------- --------------------------------------------------••-•--•-- -oun I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cty ordinances, a aws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- -- ------ -- ----------•------------------------------------------------ -(Owner and/or Contractor) By:-. �— ---- -- (TitlesN. (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----------- ADATE---- ------------------ EVIEWED BY--------------------------- ------ ------------ DATES --------------- BUILDING PERMIT ISSUED --------------------------------------------- ---------------- DATE - ------------------------- terations and/or recommendations-------------_____............... ------------------------------ ---r-- f� ' ' = --------------------------------------------- ----------------------- --------------------I------------------ ----------- 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 E5-9-2M 14$446 ATWaDD 12-$4