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APPLICATION FOR SANITATION PERMIT Permit No. ted' (Complete in Duplicate) Date Issued ---'�� An Local Health District for a permit to construct and install the work herein described. � Thilication spis hereby a to the San Joaquiapplication is made in compliance with County Ordinance No, 549. D- a,--------MA =- JOB ADDRESS AND LOCATION__. Phone------- ---------------------- Owner's ----•------------------------ -------------- - � --------------------- - Owner s Name- r ---------------------------- Address -----------------•--- Address-------------•------•------------------------ ----------- one--•---------------------•---------• - -- - Other Contractor's Name------------------------------•----- ------•- - - �' Commercial ❑ Trailer Court ❑ Motel ❑ Installation will serve: Residence f4 Apartment House ❑ �El' Number of living units: -------- Number of bedrooms ----I--- Number of baths ----I_ Lot size --------= Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. Hardpan ❑ Character of soil to a6depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam F1 Clay Loam ❑ Clay ❑ Adobe_I Previous Application Made: Yes E] No/k . New Construction: Yes No [ F TYPE OF INSTALLATION AND SPECIFICATIONS: _-------� (No septic tank or cesspool.permitted if public sewer is available within 200 feet.)r � i U --. - ----------Material------------,•- -- - -- -------•- ------------ Septic Tank: Distance from nearest well___.. ------Distance from foundaLiquid de th.__---._---Ifj"'!__--.-,°'Capacity----.V--q � ------- -- Size------�- --1-�_,�----- q p• i No. of compalrtments--__ �-------- / Disposal Field: Distance from nearest well----.. ------Distance from found ation______ ; 0----_.-.Distance to nearest lot line _ .----•---• i -. Number of lines---- 5----- Length of each line--- _�i-------.Width of tr ch_..._..._-- N ----- :, 1 -�-1 - Total len th------•---- ---- - Type of filter`material______.f[,1--------------Depth of filter material_----_t S'-------- Distance gto nearest lot line___...____.___.__ O Seepage Pit: Distance to nearest well----------------------Distance from foundation----------------- De t'n_--.- ------- Number of pits------------•---------Lining material-----------------------Size: Diameter_----------------.-- - p ❑ I Cesspool: Distance from nearest well-----------------Distance from foundation--.-__----_- --L�qu material parity__.__.__.___...___..----gals. ' ❑ Size: Diameter------------------------------------ Depth------------- - - ' i Distance from nearest building--------------------------------- Privy: Distance from nearest well '---------------------- ------------------- ❑ ----------------------------------------------- ____ -------------- ------------------------- ---------•---- --------------------------------------- Distance to nearest lot line Remodeling and/or repairing (d --------- ---••-------------------------------- --------------------------------------=---------------- -----•-------.... ' " ' ---------------------I------------------ ----------------------------------------------- be done i hereby certify that I have'predpardthiIli the Sannd that Joaquin hLocalkHeallth District. accordance with Sen Joaquin County ordinances, State laws, and ru4:74�_ regulations ------------ --------------•-------------(Owner and/or Contractor) (Signed) Title -•---- -- --- --- - ------ ---- -------- -------- By:------------------------------------- ----------•--of system in rel to wells, buildings, etc., can be placed on reverse side). (plot plan, showing size of lot, location FOR DEPARTMENT USE ONLY ---- DATE-----------srt. APPLICATION ACCEPTED BY ---------------- --- REVIEWED BY----- ---------------------------- -------- ----- - ------------------------- -------------- DATE------------ ------ ------. BUILDING PERMIT ISSUED ----=`---------------- -------------------------------------------------------- ------------- Alterations and/or recommen etions:____.____._______.- _ ______________ -------------- { --•-----------•---•-------------- ------------------------- I ------------•------- --- -- ---------- -------- - ------------------ ------- 3 ka 'f I Date.--- ----------- -_� ------ -------- ----------------------------- I- ------�-— - FINAL INSPECTION BY:--11 ---------------------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M 10-52 Revised W-2100