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i APPLICATION FOR SANITATION ¢¢ PERMIT Permit No. _,---/--�_ _ 4 {Complete in Duplicate) c, Date Issued 'A' pplication is hereby made to the San Joaquin q Local Health District far a permit to construct and install th ork her described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION___,---- ----------- -♦ �0� F 1'. � t __ __ - ---------- --- ------ Owner's Name �" > _ --------------------------------------- _._- Phone---- " --- Address----•----------•--•----- p Contractor's Name-•----___--- �-- -- -- ---------- --- Phone `"J�'G /2 Installation will serve: Residence lj Apartment House ❑ Co ercial El Trailer Court [] Mote! Eg Other [] Number of living units: _Number of bedrooms.__0_N_umber of bathsAf ------ Lot size � --f�---�-- f_--------- ----------- Wafer Supply: Public system Community system '❑ Private ❑ Depth to Water Tabla,'?,5—ft. j 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.) y Septic Tank: Distance from nearest well_ l�1tYe-_Distance fro foundation__ QIf Material--------- of compartments---I''y---- rr�, N pact -- -------------- No. _______Size_��:,��A_'��t�1-iquid depth-��--------------CapacitY--j�-.eJ;D__,_ � Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line___________.____. ❑ Number of lines---i----------------------------------------- -- ---•----Length of each line------------------------------Width of trench-------------;---------- - Type of filter material____________________ Yp Depth of filter material Total length ----------:---------•---- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-_-_________" ` ❑ Number of Pits----------------------Lining material----------------------- ------- -Size: ---------- ---------.Depth__".------------------------ -- Cesspool: Distance from nearest well-----------------Distance from foundation------------.---------Lining material____________________._:______._ ---- El S¢e: Diameter----�---------- -------- --------Depth-----------•------ ---------------------------------Liquid Capacity als. , i ----------------------------g Privy: Distance from "nearest well --_""___ ___Distance from nearest building -------------------- ------------ ❑ Distance to nearest [of line - --------- - Remodeling and/or repairing (describe):" (_1"-_-"" a 'i °' - ' w -------------- — - - -- �� ------------------------------/7----------------------------------------- - -------------------------------- - ----------------------- -•-•------------------- I hereby certify that I have prepa a this plication a d that the wor will be done in accordance with Sen aquin County ordinances2�)t e laws, a rules and eg lations of the 5 'Joaquin, oca e�alth District. r (Signed)----- __-- -• -• - �--(Owner aryl/ r Contractor) � By:----------------- ---• --- --- - ------- ------------- --- --------(Title)------ (Plot plan, showing size of lot, location of sysfem in relatio to wells, buildings, etc., can be place n reverse side). J� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----"-------:._ _-" - -------- - DATE----- -. -- ------------------------- REVIEWED BY------------------- ------------ ------- -- -- - - ----------------------------------------------------- DATE - ---------- BUILDING PERMIT ISSUED_________- _ ' ----�'" - -- --- ---------- -------- - ---=-------------------- ------------- DATE----- Alterations and/or recommendations:_____: _ --------------- -------- -------------------------------------- -------------------` ----------- ----- FINAL INSPECTION BY:-----------_ ' ------------------------------------ Date 711--d ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California • Tracy, California ES-9-2M 8-51 Revised W-2100