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♦I CATION FOR SANITATION PERMIT Permit No. t' (Complete in Duplicate) / Date Issued 4 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 wif4 County Ordinance No. 549. JOB ADDRESS AN OCATION_�. _ I Owner's Name_-__-- -- -_-- /_ ----- ----------=- -- ------ --------------------- -------------------------------- Phone-_,1 Z. Address------- � ----JContractor's Name------ -- -- - -------------- --------------------- Phone__:;__3.-- Installation will serve: Residence ❑ Apartment House ❑ Commercial 0 Trailer Court ❑ )Motel [-] F1Other Number of living units: -------- Number of bedrooms -------- Number of baths --------- Lot size ____y_O_-__ __ __ Water Supply: Public system ❑ 'Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan' Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic;Ta pistarace�fromynearest,well _Distance from foundation_______._!_-___.Material- lrt _ _________ ___ 77�� yy�� -- ---------- No. of compartments----------- ---------- Size----�_[l_U_C% -------.__Liquid depth _ -----------------Capacity Disposal Fie! Distance from nearest well---- -Distance from foundation_/_______.Distance to nearest lot line ® Number of lines--------I--------------- Length of dine---3-Q! _v#,1�yIWdth of trench-__,.. ------------------------ Type of filter material Depth of filter material____ !°--__ ____Total lent " --------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line___________-----_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth_-------------_- ----------------- Cesspool: Distance from nearest weil---------------._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 .F Remo ling�and/or repairing [describe :___-- -• -- - -_--_-- _ � ----��- �-----------------------•---•- -- ----------- ----------- --- �1r�rset -----��2�N- �;YJ -- ---- - - - ----- -- --- ---- --------- ------ - ----------- --------------- -- --- ---- -- -•---------------------------- -----------------------•----------------------------------------------------------------------------------------------------------------------------------±=--------------- 1 hereby certify that I have prepared this application and that the work will 6e done in accordan a with San Joaquin County ordinances, S laws, d ules and regulations of the San Joaquin Local Health District. (Signed)----------- - - ------------ -- -- ----------------- -- - -- ----- -- --------(Owner and/or Contractor) . $y:----------------------------- -- -- -------- ---- ---- - -------------------------------Title (Plot plan, showing size of lot, ocation f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- - - ------------------------------------- ------- DATE_------- -- - ------- - _ REVIEWEDBY ------------------------------------------------------------------------------------------------ - -------------- DATE------- 3 y__r/_ - BUILDING PERMIT ISSUED-----------------{-------------------------------------- -------------- DATE---------- ---------------------------- -- --------------------------------- Alterations and/or recommend ations:-.------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------- ----------------------------------- ------------------------------ -------•------ ------- ----- FINAL INSPECTION B ---------------- Date 7 A/— (la Q SAN.JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-5f-.Revised'01,