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� Permit No. .-__Q__�_____��--- '. APPLICATION FOR SANITATION PERMIT - (Complete in Duplicate) 11 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 L CATION-----__��_�--- ------- ----� ------- --- --- - -- ---------- Owner's Name_ t,�1 -- ----- -- - ----- one - - - •- --_ 9� Address. P--=- --------- - ---- -- -- -- - - -----`-------- ----••---• -- r --- -------- -------•---------- --j --- Contractor s Name..-- --_-{�- ----�-`-'----- -----�-�-- -- -- - • "'� ,�, -------- Phone IJ--- ---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _A- Number of baths -- _-_ Lot size _____ ----------6---0-------- Water Supply: Public system ommunity system '❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [-] Clay E] Adobe E] Hardpan ❑ Previous Application Made: Yes El No �ew Construction: Yes ❑ ,No 2--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material--------------------------------------------------`�l , F1No. of,compartments--------------------------Size--------------------------------Liquid depth------- ------------------Capacity----------------------- Disposal Field: Distance from nearest well-----------------.Distance from foundation--------------------Distance to nearest lot line____---__-------- h ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench---------_-- _--------------------- i r Type of filter material-------------------------Depth of filter material-----------------------Total length------.---------------------------------•- Seepage Pit: Distance to nearest ell____-----------------Distance and ion_-__-� __..Di t ce to nearest lot . _- Number of pits------I1��r� Lining material__irlele: Diameter---- -------- -----Depth----- - !------------ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-___.__----------------___-_____--- :f ❑ Size: Diameter------------------------------------- Depth------- 1-----------------------------------------Liquid Capacity----------------------------gals- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building--------------------------_ ❑ Distance to nearest lot line------ ------------------------------------------------------------------------ le IC2, 4a = ---- Remodeling and/or repairing (describe):------- -.-...- Y •------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify +hat 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. (Signed) - - �-- - !_. ° - {Owner and/or Contractor ----------------- BY:--- ------- ------ win size of lot location of system in relation to wells, buildings, etc., can be p1 ced on�reverside). Plot plan, showing g Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -------------------------- DATE ------- -------------------- REVIEWED BY------------------------------------ �' DATE/ ----------- BUILDING PERMIT ISSUED----------- --------- - DATE Alterations and/or recommendations------------------------ --------------------------------------------------------------------------------------------------- ----•------------------------- -------------------------------- ------------------- -47 ---------------------------------------------- ------------------ ---- ---------------------------- --------------------------------------------------------- D FINAL INSPECTION BY:e -- �� q" ate- -------------------------------- 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 b / ES-9--2M 8-51 Revised W-2100 t