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APPLICATION FOR SANITATION PERMIT Permit No. -/-- •�-••_ [Complete in Duplicate] Date Issued 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 with County Ordinance No. 549. JOB ADDRESS AND LOCA_ TI ----------------------- y ---------r-'`'. '. Phone „ ---------------- Owner s Name_ - -- - ----------------------- --- - Address.. _ _.. _ F _ ---------_ _ - Contractor's Name_________ _ -------------------•------- .. - ---------- Phone 1 m --rci l El 1"Trailer Court ❑ Atef .� - t r - - ------ --- -------------------- nstailation will serve: Residence Apartment House ❑.� Commercial ❑ O#her ❑ Number of living units: ---I--- Number of bedroomsNumber of baths Lot size ___ _ _ "�-_ . --------------- --- Water Supply: Public system ❑ Community system ❑ Private�Depth to Water Table _:______ ft. r Character of soil to a depth of 3 feet: Sand ❑, Gravel ❑ Sand Loam Cla loam Cla Y ❑ .Clayj, ❑ y ❑ Adobes Hardpan ❑ _ r' Previous Application Made: Yes ❑ No New Construction: Ye No ❑ rv � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ __Z---Distance from foundation___ _ f M�a�^ter,i�al____ __ 19 No. of compartments--------------------------Size--L, _ -- —Liquid depth---- "#} " --- Ca Capacity � - pY----- _ Disposal Field: Distance from nearest weli---- --- _. istance from foundation___t�._ Distance o nearest lot line_t,j_�e -_ Number of lines-------------- /------------- ”--Length of each line____-- _-� � . � �- ""----.Width of trench-- -- '-- of filter material_,_ -" -- Depth of filter materia______ _ ___Total length__ ___ ----------------- Type '. Seepage Pit: Distance to nearest well------. ___--- Distance from foundation------------_-------Distance to nearer# l`o`t line________________ _ ❑ Number of pits----------=----------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well----------------- from foundation___....----------_Lining material_____________________ � ❑ Size: Diameter__-"- - -Depth---- ---- --- --- --Liquid Capacity -'"!'Prrv -., � Disfiatr�e=frorn-n �rrs - gals. _____------------------- Distance to nearest lot line___ _ _____ Remodeling and/or repairing (describe):__.----------------------------------------------------------------------- ----------- -------------------- -•-------------••---------------• l ----------------------------------------------------------- ------------------------- --- -- `------------•----------------•--------------------------------------------------------------------------------------------------------------------------- - I hereby certify that_I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. L (Signed)- -------- ----------- L __ - (Owner and/or Contras* j B -------------------- --------- i (Title) (Plot plan, showing size of lot, locafion`of system in relation-to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------------------ t _ -- -- -------------------------------------------------------- DATE + "1 t REVIEWED BY------------ -------- ----- DATE BUILDING PERMIT ISSUED------••------ -------------•---------------------- ------ --------•------------------------------------------------ DATE-------------------- Alterations and/or recommendations:---------.--------------"-- --------'------•-------- -------------- ------------------- -------------------- ----------- --------•------ ---- ----- -- _ - --- - --------• ----- �_� �. ,r . - ---- ------------- ----- ---- -------- f � - - - --- - - _ 7t U a �1 - — ''g..._ _ FINAL INSPECTION BY--------- -------- - ------ Date------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT } 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S}reef Stockton, California Lodi, California Manteca, California Tracy, California N F ES---9-2M 8-51 Revised W-2100