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APPLICATION POR SANITATION PERMIT Permit No.X ---------- (Complete in Duplicate) Date Issued- _f_--��'-S Joaquin cal Health'District for a permit to construct and install the work herein described. Application is hereby made to the San This application is made in compliance with Cou Ordinance No. 549. 1 JOB ADDRESS LOCATION - y �] y -------- Owner's Na a I -- ---- --------------------------------------- Phone l ( SO Address --- =---•------------------•------------------------- --------------- Contractor's Name - Phone - - ------ - ---- - Installation will serve: Residence ❑ Apartment House f r Commercial ❑ Trailer Court ❑ Mofil ❑ Other ❑ Number of living units: : er of bedrooms --- Number of baths .-_1___ Lot size _�fJ---��_�_�___,----___________________ Water Supply: Public system ;�=unify system '❑ Private ❑ Depth to Water Table ------- ft. +: S��ONew Grave! Sandy Loam Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Character of soil +o a depth of 3 fee ❑Previous Applica+ion Made: Yes ❑ No Construction: Yes g No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Fi (No septic tank or cesspool permitted if public sewer is available within 200 feet. ► Septic Tank:' Distance from nearest well- -----Distance fro j ound • n--- _` __ __-_-.Material ----- �- t -t_�s-. p + x�(!-� Liquid depth----------- ------Capacit '7 -- . No. of com artments------------Z-- ----Size----_------ ----- - Y Distance from founclati n__ -- - --_ Distance to nearest loft lin Dispos Field: Distance from nearest well------ ---___ J 1�lir` - rZd Length of each lin ___ - 0----- ,5.o---.Width of trench----- �-moi ----------------- Number of lines----------- -- ------- - g - I- �5 Type of filter materEa- --��Depth of filter material-_____I_�- -____ Total length -----/--1-0--------------------- 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 __ ---_ ---Ligning material y _-�_----__-_- Size: Diameter T WDe +h�=_ Y -=` = - ---- --L-i uid Ca acit` gals ❑ ,.� -r . ._ Privy: Distance from nearest well------------------------------------------------Distance from nearest building--- ----.• ----------------------- • Distance to nearest lot line-------------------------------------- --------------------------------- -------------------------------------------------------------------------------------------------- I Remodeling and/or repairing [describe}______________________-_--______---------------------- 4 ----------------------------- -- ------ - --- - --- -----------------------------•------------------•------------------------------------------------------------------------------------------------------------------•------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S�to laws, and rule and'reg ations f +he San Joaquin Local,,Health -st ct-- - r _ �V -{Owner and/or Contractor) F 1 (Signed)-- P-1 --- , 1�6? (�} --- ----- By:.--E� ",*� ------ (Title)__ ------------------ ------------------------------------------------ F (Plot plan, showing a of lot, loco ion of system in relation to wells, buildings, e+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ----------- -- ----------------------------------------------------------------------- DATE__ ----------------------------------------------- REVIEWED BY------------------------------------------ DATE--- izi BUILDING PERMIT ISSUED------------------------- - --------------------------- DATE---------- ffl Alterations and/or recommendations---------------- -------•------•--------------------------------------------------------------------- � -------------------------------------------------- ---------------------------•--------------- ------------------------------- ` `I ------------------------- ------------- ----------------------------------------------------------- -------------=--------------- ----- Date-------- _ --------- ----FINAL INSPECTION BY:__ '- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street 614 Horth "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100