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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica{ion 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. Ad _ _________________________________________ JOB ADDRESS AND LOCATION__.1VIXI- -J00-K----- �' + Phone------------------=-------------- c --J-----._ -------------'-- ---------------------------------- wner s ame__________________ _ -------------- Address ='----------------- '------- - ---- t --------••------------------------------------------------- .-•---------------------------•------------------------------- Contrac#or's Name-----�-------•------ r� .IJ'l�Y�/ ? Phone Installation will serve: .Residence a Apartment House ❑ Commercial ❑ Trailer Court El Motel [j Other E]Number of Diving units: ____;__-j Number of bedrooms __P...1 Number of baths -------- Lot size ----------- Z--x- 0------------------ Water Supply: 'Public system ;Community system ❑ Priva"te'( Depth to Water Table --4-5- ft. ' F Character of soil to a depth of 3 feet: Sand ❑1. Gravel I—] SandyLoam El ay Loam ❑ Clay [j Adobe Hardpan ❑ Previous Application Made: Yes 0 No New Construction: Yes No E] S TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool.permitted if public sewer is available within 200 feet.) i t . - _ . !- Septic Tank: Distance from nearest well____5'0-____.__Distance from foundation-----1D_____-___.Material-------- -------- =-------------------- L s '�� 3 Liquid dap#h yJ! Capacity----- �} f No. of compartments-------------------------- Disposal Field: Distance from nearest well--.._S�-r .Distance from foundation------2Q_�___.Distance to nearest lot line-_____ ....- .Number of lines------ �---- - ----------Length of each line---/_.7a --------------Width of trench------....------------------- Type of filter material-----)jkJ'�,-f---Depth of filter material___.___Ik-_ --_____Total length--_-_____,��__ ___________________ Seepage Pit: �� Distance to nee4arest well------------------.---Distance from foundation--------------------Distance to nearest lot line-----------.----- Number of pits---------------------Lining material----------- ---Size: Diameter-------------- --------Depth------ -_----------------------- \ Cesspool: Distance from nearest weld-----------------Distance from foundation--------------------Lining material-____..______-______:___________---_El (� Size: Diameter'------------------- -----Depth---------------------------------------------------Liquid Capacity-------------------- •------gals. Y� Priv Distance from nearest well____.4-------------------------------------------Distance from nearest building----------------------------------------- - E. f t ❑ Distance to nearest lot line-------- --------- ----------------------------- ---------•----------------------- Remodeling and/or repairing (des-cribe):-------- " �--------------------------------------------------------------------------------------------------•---•-----------------...------- I : I. --------------------------------------------------------------------------------------------- - - -------------------------------------------- ---- = -----------------------•------------------------•----------------------- 1 ----------------------- - ----------- - �-------------------------•------------------------••-------•------------------•-•-------------- ---------------- I hereby certify that ! have prepared this dp 9ica tion and that the work will be done in accordance with San Joaquin County ordinances, State laws{an ales a d regulations he San Joaq in Local Health District. (Signed). ---f ---- - -- ------------------------------------------- ---------- (Owner and/or Contractor) _o - -- ------ --- -------- ----------- Title (Plot pian, showing size of lot,-location of system in relation to wells, buildings, etc., can be placed on reverse side). r 1 , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ----- -- DATE--------- r_ '----•---------- REVIEWED BY------------------------ ------------- ---------- -- --------- ------------ - ----------------•-------------------- DATE-------------------- -----------•------------------------- BUILDING PERMIT ISSUED---------------------= --------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------i--------------- ------•---------••-•-•---•------------------------------------•------------- --------- ------•-----------•---------------------------- ----------------------- •..------------- ---------- --------------------------------------------- ---------------------------------------- a ---- ------------------------------------------------------------------------------------------ I ---- ------------------------------------------------- FINAL INSPECTION BY:. S . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2140 f