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ej I APPLICATION -FOR SANITATION PERMIT Permit No. _ _�----------- (Complete y____(Complete in Duplicate) ' bate Issued __� 5--'------'--S V ------ 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 ADDRESSr�D ,LOGATIO ;�.4_Z_ X___ aOwner's Name -------- - --------------------------------- Phone-4--------------•--- i Address_-•-----Z---& -- ------------ ------ -- Contractor's Name --�-------- ---------------- Phone------------------------------------ Installation will serve: ResidencerApartmenf House Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of livingunits: ___ Number of bedrooms _++_ c� a 15,t_ Number o baths ___ ___ Lot size .___ '7___________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LClay Loam ❑ Clay ❑ Adobe�ardpan F]Previous Application Made: Yes E] No [,/ New Construction: Yesaam No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public �� ewer is available within 200 feet� 1 Septic ank: Distance from nearest well__ V____Dista e fro �foYun�dat�on__________________ Mater' _ __ -------------------____ __________. No, of compartments_-_______-__ Size_ X_ -_✓ 3__Liquid ep --- -------- .Capacity Dispos 1=ield: Distance from nearest well_C50-_C50 -Distance from foundation_ __Distance to nearest lot li e�_ __-•._• Number of lines___________►__ Length of each line-----� ________ Width of trench______� _�_______________ Type of filter materiaSt __-Depth of filter material_____ _____.___Total length.........4.1 _6__ _-_ 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 well-----------------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 Remodeling and/or repairing (describe)----------------------------------------------------------------------------•- -----------•- ------------------------- -q--------------------------------------------------------------------•----•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rules nd re ulatio of the San Joaquin Local Health District. (5igned)_.. • ------------------------------------------------------------------------------------(Owner and/or Contractor) By:------------------- ----------------------------------------------------------------------------------------------------- ----(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPA 5TMEK USE Or APPLICATION ACCEPTED BY_--_____ -------------------------- ATE--------- --------------------------------------------------------- -- - --------------------------------------------- -- DATE BUILD NG PERMIT 1SSUED------------------------------------- -----------------=--------------------------------------------- DATE---------------- Alterations and/or recommendations:------------------------------------------------------------------- FINAL INSPECTION BY------------------ - - --------- Date--------- 4f ' - 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 8-51 Revised W-2100