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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica%n 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__-- -_ -------•- ------- wner's Name___ __ __ _ ____!.- --- --------- -- -•-------••----- - ------------ ---------- ----------.a-::_ ------------- Phone.---�--•--------------•-- --- - - Contractor's Name.___ _. �-- ----•__ � - --------------- Phone Installation will serve: Residence A---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:____ Number of bedrooms ___..Number of baths _�____ Lot size __ x �..'"''-_ ----------------------- Water Supply: Public system munity system ❑ Private ❑ Depth to Water Table _21Sft. Character of soil to a depth of 3 feet: Sand'[–]' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ , Previous Application Made: Yes ❑ NoMt—NEW Construction: Yes ❑ No w TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well-----------------Distance from foundation--------------------Material _.____-____._.____----_.-_-_- No. of compartments--- ---------------------Size-------------------------- -----Liquid depth.-------- ` ------ ------------------------------------ ---------- isposal Field: Distance from nearest well +. -Distance from foundation.__ <�.-- Distance to nearest lot line___ 06-1 r i C� . Number o7 lines------.--� .r-- --4-- ---Length of each line-----/0- - �----._.Width of trench__-- �1______.___ Type of filter material_.__ ___.-____---De th of filter materia!___._ -._ c� Totaf len th-._. -__-__-----_ _ Depth 4---------. 9 /4r- le Seepage Pit: Distance to nearest welt ________Distance from foundation__---____.__.______.Distance to nearest lot line----------------- ------------------Number of pits_ ------------ -----Lining material--------------------- Size: Diameter------------------------Depth.-.-------- ------ Cesspool: Distance from nearest we!! -_Distance from foundation------.---------....Lining material------------------------------❑ Size: Diameter...... -------------------------Depth-------- ------------------------- ----------- ---Liquid Capacity gals. ----g rivy: D+stance from nearest\well-------------------_------------------------.---.-Distance from nearest buildin g ❑ Distance to nearest lot line------------------_________ _ Remodeling and/or repa.n g describe) -..____________________ ----•--------- ------•----------- Y` --- �' --------�:---- L; , - 1 <<^.. -------•--- ....... 1 Z t-=- c.�..��Q� ------------- ----- -- -•-------� ---- ----------- e .ncxP ° �-� ------------------------------------------------ -----------------.------------••------------- - - I herebycertify that I have - - - - - ---------------- Y 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).-- ---••----------- -------- ----- ----- ------------------------------- ( Contractor) BY: = ------------ ---------------------------------------------------(Title)------------------------------------------- --------- (Plot plant 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 - ---------- BUILDING PERMIT ISSUED--------------- ----� ------ ------------------------------- DATE ? Alterations and/or recommendations:___________________ ------._ --- ----- FINAL INSPECTION BY:_.__------------- °"�� ----- --- --- --- ---' Date r ?-------�---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheet 300 West Oak Streef 132 Sycamore Sfreaf SIS North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M iysacs arwoao 12-s4