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APPLICATION FOR SANITATION PERMIT Permit No.c-__-9� / �11, (Comple+e in Duplica+e) bate Issuedication is hereby made to the San Joa ui n Local Health District for a permit to construcfi and install the work herein described. pplication is made in compliance with County Ordinance No. 549 JOB ADDRESS AND LOCATION.___ Q _ Owner's Name_________________ ------------------------------------- ----- -------- - Phone_ -•-------- Address _ --—------ -- _ ---- Contractor's Name_.------- G - � ___ -- - - - Ar -------- --------- Phone.---- -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _Number of baths _Z_ Lot size ______ _aC/�/� S._(� ----------- Water Supply: Public system [] Community system ❑ Private Depth to Water Table3.0_ ft. Character of soil to a depth of 3 feet: San ,-Gravel ❑ Sandy Loam ❑y Clay Loam ❑ Clay ❑ Adobe[ F-fardpan [] Previous Applica+ion Made: Yes ❑ No New Construction: Yes n No ❑ 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-----------------Distance from foundation__________________.Material_-____..___-_..._________________-_ - �y No. of compartments Sixe ------------ ' --------Liquid depth-------------------------- Field Distance from neares weiLlGr.____bistance from foundation_ _ ---- i��______.Distance to nearest lot line___.____.___ ❑l/+ Number o7 lines------1 m _.__ ___Length of each line_�_ '�jWidth of trench.-___. f " r� ------------------- ---------------- Type of {filter material fir_ E -!__Depth of filter material----1.�______--Total length-------- �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 we}I-----------------Distance from foundation___-_---------------Lining material-----_---------------- _ ❑ Size: Diameter--------------------------------------Depth------------------------------------ ------------ --Liquid Capacity - ----------------------------------- ---- ---------- ----• Privy: Distance from nearest well---------------.---------------------------------Distance from nearest building.-- ------gals. El Distance to nearest lot line-_____ _-______ Remodeling and/or repairing (describe) ------------------------ :_______- �' -- ----------- = ` ------------•-------------•- •-------------- - - ----------------- - .------- ------- ------ �-� ------ ------------------------I-------- ----------------------------------------------------I-------------!----------------------- ------------------------ -------------------------------•---------------------------------------•--------------- ----•-- --- ----------------------------------=------------------------------------- --------- 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 reguI tions of the S n Joaquin Local alth District. ----- - - - - f 1-- ---'�L /- -----------------(Owns -and/or tractor) By:----C:r `--- --- - .. -------------------------------------------------------------------(Title)------- [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------------------------- u . ------------------- ------ ------ --------- - ----------- ------ ----- DATE----- ------------------------ ---------------------------------------------- UILDING PERMIT ISSUEQ_-. ----- ------------------- ---------------------------------------------------------- DATE----- Alterations and/or recommendations --------------------------- FINAL INSPECTION BY - ............ ------------- ------ Date --- -------- ---------------- 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 10-52 Revised W-2100