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APPLICATION FOR SANITATION PERMIT Permit No ................ 1�e (Complete in Duplicate) Date Issuedplication 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 LOCATION----------1�•��----)------------ -&8 c-------"�v---------- ------------------------------------------------ Owner's N-C L - Owner's Name---------------fix �- -- -------------- -------------------- ----- --------------- Phone-------�-�----- ---7-- ---- . ----------------------- ------------------- ----- Address------------------------- �P I -------- ------ ---------------------------------------------------------------------------------------------- - -------------------------------------------- Contractor's Name--------- V G�--•----------------------------------------------------------------------- ----------------------------------- Phone----------------------------------- ---------- - Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ `5� Number of living units: -------- Number of bedrooms _______ Number of baths _______ Lot size _______ ��_X__ '`" Water Supply: Public system ❑ Community system ❑ Private, , Depth to Water Table _---_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adoboo Hardpan ❑ xE Previous Application Made: Yes ❑ No D( New Construction: Yes No ❑ 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest we{i 0 ____._Distance from foundation----�Q-________.Material-- d --_________- ,}� �I No. of compartments- ----�------------Size----��--��---�a,�---Liquid depth--------------------------Capacity----�QQ-------- 4 Disposal Field: Distance from nearest well-4 .___._Distance from foundation___ ..........Distance to nearest lot line_____- r____--_ Number of lines-----�f____--_ --_---Length of each line_____ Width of french_________2�a_`.._______ Type of filter material-------------------------Depth of filter material----------------------Total length_______ = ------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.------Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material--------------.-------:Size: Diamefer-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material______________________________-_•___-.El t Size: Diameter--------------------------------------Dep#h- •------- --------------------------------------Liquid Capacity----------------------------gals" Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________-__-____________________________ ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):----------------------------------------------------------------------------.-----------------------------------------------------------------•--..... -------•-•----------------------------------------•-----------------••---- ----•--------------------------------------------•---•-------------------------------------------------•--•----------------------------.----- -----•----------•-------------------- ----------------------------•-•----•------..-.-•-•-------------------•--------------------------------------•------------------.-.-•----•----••------------------------------.. hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin C4,-unfr ordinances, State aws and-rules acid regulations of the San Joaquin Local Health District. (Signed) --------------- ------ -�- ------------- ----- -------• ------ - - - - - - - - (Owner and/or Contractor) By:....---------------------------••--------•... --------------------------------------------------------(Title)-----•----------------- (Piot 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____________ __�_ { -- ------------------------------------------------------------- REVIEWEDBY------------------ ---------------- ------------------------------------------------------------------------------ DATE-------------------- BUILDING PERMIT ISSUED------------------------------------------------ -= DATE --------------------- Alterations and/or recommendations:_..)- -------------------- L. - � - PZ"�-- - - - --- ------- -at- ------------------------ -------------------------------------------------- --------- FINAL INSPECTION BY.,-- -------------------- 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