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APPLICATION FOR SANITATION PERMIT Permit No. .___-_- yA (Complete in Duplicate) 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. t K/�-------- i JOB ADDRESS AND OCATION__ 0 ------•----------------- ----- - Owner's Name------- ------�-- - Phone Address.. � -------------------------------------------------------------- �a Contractor's Name--------- _._ . --- Phone--'�� 4 . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motes ElOther ❑ Number of living units: ._-_ Number of bedrooms .°Z." Number of baths ._/___ Lot size ______ ----------------------- Water --------'-----------Water Supply: Public system Community system El Private'❑ Depth to'Water Table �A ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E] i Previous Application Made: Yes ❑ No X, New Construction: Yes ElNoX TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Materiai____._______.___---__-.-.._.-.____._____._------� ❑ No. of compartments --------- -------------Size---•----------------------------Liquid depth--------------------------Capacity----------------------%40 __Distance from foundation-------------------- to nearest lot line. Disposal Field: __-_______._....� Distance from nearest well-_______________ ❑ Number of lines-----------------------------------Length of each line-----------------------------Width of trench---------------------"-- Type of filter material-------------------------Depth of filter material-----------------_o---Total length------------------------------- rest Pit: Distance to nearest well_-_-_._._______-_._}Distance from foundation____'d___-_'VO -Distan Distance to nearest lot line_z_._. Number /.------Lining material_5'• I^Agk-Size: Diameter_-____�-� -------Depth------a- ----------------- Dumber of pits__.__.___ - I esspool: Distance f am nearest well_--_______"___'_Distance from foundation----____________..Lining material. ❑ Size: Diameter--------------------------------------Depth--------------------- ------ -------------- ------Liquid Capacity----------------------------gals, Privy: Distance from nearest well--------------------------.----------------------Distance from nearest building------------.----------------------------- ❑ ----------------------------------------- Distance to nearest lot line------------- - --------------------------------------- - ----------------------- Remodeling and/or repairing (describe):-- ---------------- -"--------------------------------------------------------------------------------•-•--------- ------------- -•-------------- 11-----------------------------------------•- --------------=----------------------------•------------------- ------------------ 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 regulations of the San Joaquin Local Health District. Si ned - ._. ------[ ner and/or Contractor) ( 9 )------------------P ------------ . . ---- ---- --- ----------------- By:--•----------- �k " --------------- ---------------------- 1 (Plot plan, showing size of lot, location of fe m in relation to wells, buildings etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---'-I--------------------------------- DATE------ �•--- �{ - REVIEWED BY ------------- -- --------------------------- -" -- DATE BUILDINGPERMIT ISSUED---------=i ----------------------- ------ DATE------------------------------------------------.------------ Alterations and/or recommendations----------------------- - -- - ----•----------------------------"---------------------------------------------------------------------------- - - - - - ------------- i I --=-----------------------------------------------------•----------------- k -----•-, "------------------------ ------ ---------------------------- ---- ......... ---------------------------------------------------------------•- ----- --- A FINAL INSPECTION BY:--------� ---------� - ---------- Date M ± SAN JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 814 North "C" Street 130 South American Street I 300 West Oak Street 132 S Y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100