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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ___��7��__ 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. JOBADDRESS AND LOCATION. tom`( ✓a---------- ------------ ---- - ---•---------------------------------'---..------------------------------------------------- Owner's Name ----- -- ------ ---- Phone Address----------------------- -•----- - - -- --..,:-------------- -------------- •- -----�--f- - ---.. .---------��;�.:--------------------------------------------- �.; --- ---- ...... - ---- Contractor's Name____:_ Phone _ T .fes. Installation will serve:,, Residencepartment House ❑ Commercial E�- firailer Court ❑ Motel ❑ Other [❑ Number of living units: 0--_ Nu ber of bedrooms .. _ Number of baths3-___ Lot size ___.�7__.._�----/._� ________________ Water Supply: Public'system' Community system ❑ Private ❑ Depth to Water Table -------- ft. '- Character of'%oil to a depth of 3 feet: :Sand ❑ ..Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adoberdpan ❑ Previous Application Made: Yes New Construction: YesL�—No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is available within 200 fe'Iet.) f Septic TanlL- Distance from nearest well------------- --Distance from foundation_________:--__-.-_-- JW / No. of compartments-_------ --- -----------Size---------------•--------- - ---Liquicl depth------r-- ----------- --Capacity----- Disposal Fielder Distance from nearest well-----------------Distance from foundation---------------------Distance to nearest lot line_-__.--_.__._._.. - Number of lines----------------------------------Length of each line--------------_-------,------Width of trench----------------------------------- T;pe of filter`material-----------------------_Depth of filter material--------,_..__.__----_Total length---------------------------- f Seepage Pit: Distance to nearest well_ _ istance f m fo dation__/lL Distance to nearest lot line-_____-___ Number of pits....... Lining material ___._ ._.__.Size: Diem ter._.._ _ "_Depth......... ____________ f Cesspool: Distance from nearest well-__.______;-----------------Distance from foundation--------------------.Lining material_.____..____.__-_.____________---- i[] Size: Diameter--------------------- -- ---..De th-------------------------------------------------Li Liquid Capacity_' p q p Y ------------------------ gals. Privy: Distance from nearest well---- --------------------------------------Distance from nearest building----------------------.__--_..__________- ❑ Distance'to nearest lot line----------------------------- ------ -----------•----------------------------------------------------•---------`--- --------------------------- Remodeling and/or repairing (describe): ----------- 1f / .. ' 1e. -------- ---- --------- -- --------------------•- --- -------•-`-----------------------------------•--•----•-----------------•--------------------------------. -------------•-----••--=- = I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulesiand regulations of the San Joaquin Local Health District. (Signed).-•---------------- ----=---------------- - ------------------------------- :-------------------------------------- ----------- ---- er and/or Contractor D &NIGHT Tale By: a �----r-�------------------- ( ' (Plot plan, show f I°� I�" �r4�iado-..1f70ia to wells, buildings, etc., can be placed on reverse side]. R DEPARTMENT USE ONLY K APPLICATION ACCEPTED BY--------- ---- ---------- - -------------------------------------•-•----------- DATE------ -- —7 -Z/-------------- REVIEWED BY-------------------------------=------------- ------- ------ DATE------ ---- --------------------------.--------------------- BUILDINGPERMIT ISSUED------------------------------ --- ------------------------------------------------------------------ DATE.........._------- ----- •---------•----..._.._ Alterations and/or recom endations:---f_ .__............. ...... .. = - =- ----. Q - ____ _______________ _ ____ = -- -------------------------------•------------------------ ---------------- -- -------•----------------.....-•-------------------------------------------------------------------•------------ FINAL INSPECTION BY:.----- - ------------------------------ Date----- - .---------------------------------------- 1 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 ES___9-2M 145446 ATWVMD 12-54