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n APPLICATION FOR SANITATION PERMIT Permit No. .-- 9. (Complete in Duplicate) �-�— �. _ Date issued 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. 4&7JOB ADDRESS-AND OCATION.�- ------ ------------ -•-- ---------------------•---._._-..----------------------------------------- x. Owner's Name = -------------------------------------------- Phone------------------------------••---- Address........... _... --- ------------------•---•------------------------------------------------- :..... Contractor's Name..... ----•----•--------------------------------------------------------------- ----•--- ------------- Phone-.-----•---- -------•---------- Installation will serve: 'Residence �Apartmenf House E] Commercial ❑ Trailer Court Ll Motel ❑ Other El Number of living units: __C____ Number of bedrooms ___]__ Number of baths -______. Lot size ------ _____________.__ t Wafer Supply: Public system ❑ Community system ❑ Private k Depth to'Water Table q__0 ft_ tuv_a gl� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy.Loam ❑ Clay Loam ❑ Clay ❑- AdobeHardpan ❑ Previous Application Made: Yes E] No New Construction: Yes ❑ No E] 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.90,Q___._.Distance from foundation_-IQ_________.Maf rialla-&-j-07-64__ No. of compartments------ ,______________Size__ __ _ rte ___Liquid depth______ _.__.__.__e____Capacity---- Disposal Field: Distance from nearest well._.20----Distance from foundation---1b----------Distance to nearest lot line___--- r Number of lines---------I------------------------Length f each line-----�_-©----------------Width of trench_-- ---�!__-- -----____-- T `e or filter maferial-d_ yp r l.� C f filter material___��_�`--------Total length-_______6-G-,! � Seepage Pit: Distance to nearest well----------------------Distance from foundation.....................Distance to nearest lot line______._____-_--- . ❑ Number of pifs----------------------Lining material--------•--------------Size: Diameter------------------ '___Deptn----=---------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------.-----Lining material----------------_-------------_-___-_ ❑ Size: Diameter---- - -i-----------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well ___________________________________-----------__Distance from nearest building----------.__________________.__._._._.__ ❑ Distance to'nearest lot'Iine_ '__._______- -------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)---------- -------------------------------------------------------------------------------------•-------------•----------------------------=`- --- •-----------•----•-•---------------------------•--------------------------------•-------------------------------------=- -----------------•-----------------------••---•--------•• -------------------•-•-- -------------------------------------- -----------------------------------•-------------------------------•----------------------------- -•------------------------•--------•-------- I hereby-certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 4 ordinances, State laws,'and rules and regulations-of the San Joaquin Local Health District. (Signed)--------- --- -1� i ___________________________(Own,er and/or Contractor] By --------------------------------------------------- ------------------- =T ----------------------------------------•--------(Title]--------------------------------A------------------------------- (Plot ----------------------------- A------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- --- --- ------------------- ------------------------------------------ DATE.---- REVIEWED BY-------:------------------------ ----------- - -------------------------------------------------------------------- DATE---------------------------------------- -� BUILDINGPERMIT ISSUED---------------------------- --- --- ---------------------------------------------------------•---• DATE Alterations and/or recommendations------------------ . ------------- 13 -- ---•----------------•--------------------------------------- -----------� --- --- --- l •-------------------------------- ---------------• ..---- ----------------------------- ------------------------------------I------------ •--------------------------------------•----------------------------------------- ------•----------••-------------------•-------------- ------------------------------•---------------------- ` FINAL INSPECTION BY: ------------- ------------------- Date__:c�_�__ � �� ----------------------•------- I SAN JOAQUIN LOCAL HEALTH DISTRICT , ! r 130 South American Streot 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California L6di, California Manteca;California Tracy, California ES-9-2M Revised W-2100