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Permit N vim6 APPLICATION FOR SANITATION PERMIT / .-- - (Complete in Duplicate) Date IssuecIAK 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. /-{ /� ST ' G d '°` 7�' --------------------------------------- JOB ADDR SAND LOCATI N---•-�-----I�------- --- -- - -- �-----�------------•------- ---------------------- - ------ Phone---------- ------ Owner s Name__._______________------- _ l Address ��- ---------------------------•------------------- ------••-----------------------------------------------------------------•• .� - ---- -------- rn Contractor's Name-----------------------------------------------r------ ---------------------------------- -------. Phone---------------•------------•------ 1 Installation will serve: Residence �, Aparfment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E❑Number of living units: _ .._-_- er of bedrooms __`_Number of baths ---f-_ Lot size ------- v-x_____/ - •-------•------------- Water Supply: Public systemommunity system ❑ Private ❑ Depth to Wafer Table .------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EF-Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No [W"' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within on feet.] Septic Tank: Distance from nearest well -_--__Distance from faun ation__, _______.Material_______----. -------------_--- __ VILA No. of compartments---•----y---------size-- 7:------Liquid dep h 0.`� Capacity a Dis Field: Distance from nearest well....- ____Distance from foundation--_�0-----_-_Distance to nearestaot-line--_--- - ---_. Number of lines--------------- ---- ----- ---Length of each line---- -------------Width of tre --- - "-------------- Type of filter material 1 —Depth of filter material-._.. ____�P ��----Total length___------------------- zQ-__---. 4 ---.___.Distance to nearest lot line.-___--__--.__-_ Seepage Pit: Distance to nearest well_----.-____----.f_ -Distance from foundation_.-._-_..._ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter----'-f---- ---------.Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ` ❑ Size: Diameter------------- ---•--------= ----==-Depth---------------------- --- •-------------- ------__-Liquid Ca Paci}Y- -----------------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------.------- ❑ Distance to nearest lot line--------- -------------------- - ----=-----------------•------------------------------------------------- -- Remodeling and/or repairing (describe):-------- ------------ -------- -- --------•-------•----- � ----------------------------------------.--------------------------------------- -----•----------•--------------------------------------- -------•----- ......--------------------------•----------------- ------------------------------------------------- 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 reg ations of the San Joaquin Local Health District. , � ----------------------_____--(Owner and/or Contractor) [Signed}_ ------ �` B : = 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 - REVIEWEDBY-------------------------------- - ------- DATE--------------------- = BUILDINGPERMIT ISSUED---------------------------------- --------------=--------------------------------- DATE--------------------:------------------•--------------------- ' Alterations and/or recommendations---------------------- - ------ ------------- ---------------_- ----- ------------------------------ - -------------------------------------------- -------------- ---- •---------------------------•---------------------------- "� ---- ��, r� � �." FINAL INSPECTION BY:.. --------------------------------- Date. f � r - SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California