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APPLICATION FOR SANITATION PERMIT Permit No.' 7'_-.0.7 (Complete in Duplicate) Date Issued _7�_l" pplication is hereby made to the San Joaquin Local Health^Di This application is made in compliance with County Ordinance NoC549r a permit to construct and install the work herein described. JOB ADDRESS AND rCATfON.__"__ �_ _"- •"" " --- ---- Owner'sm ------- Address.. -- ----------•----- - _ ------ Address.. ------------------, - -------------------------- - Phone. --------•- ----- -- i •-- -----•--------•-----•--------•-----------------•---------------- =Contractor's Name"""_"._-._" __" _"- --------- nnmo --- - --- - Phone" f" . ------ Installation will serve: Residence Et"Apartmernt House ❑ Commercial ..�,,._ „�„ El Trailer' Court E] Motel F] Other Number of living units: _-r _" ❑ _ Number of bedrooms -_ e Number of baths __.l_ Lot sizeQ Water Supply: Public s stem """"-'--------- -""`------- PPy� y Community system ❑ Private ❑ Depth to Water Table11ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic fanlc or cesspool permitted if public sewer-is available within 00 feet.) Septic Tank: Distance from nearest well-------.--_-.__-Distance from`foundation_"-""-_N-___-"_____.Material ❑ No. 'of compartments-..---_-......-------------Size----------------------------_ Liquid depth--------- -- Capacity Disposal field: Distance from neares w l_ __ Distance from foundation----�i-" 41"" _.Distance to nearest lot line-"-"""Q_-_�_•_. _r Number of linesd__ „ �� Length of each line-----I�12-Ty Width of trench" T e of filter material ---""" r T Type �1e4 Depth of filter materral" �__ T_:Total length------" --------------------------------- Seepage,Pit: Distance to nearesttwell_"_:��--T_--Distance from foundation--". v_ p p C Distance to nearest lot line- Number of its-"""';�_--""___-----Lining material. I � -_Size: Diameter------3. Depth----G2 Cesspool Distance from nee est well-------------- Distance from foundation__". Lining material_ ""-_-----_.--__.-_-- ❑ Size: Diameter Y: Distance from nee i "" - -----------------------------Depth --------- --- ------------- - -----------Liquid Capacity--- = Priv � r ;`t 'gals, rest well_.-__---__-- -" _----" Distance from nearest buildin ❑ Distance to nearest lot line ---_ -- g Remodeling and/or repairing (describe)-------------------------------- ' -" - --------- .. ------------------------------------------ -"---•-------------------•-----------..-----------•----------•--------------•--------------------------------------------- ------------------------------ I hereby -by certify thaf I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,`and rules and regulafions of the San Joaquin Local Health District. (Signed)•----- ------ ----------- ------------------- Pwner and/or Contractor) (Plot plan, showing size of lot, location of sy -- - sfem in relation --------(Title)----to wells, buildings, etc, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------" REVIEWED BY - ------------------------------------------------. . 6DATE ;5 } BUlLDING PERMIT ISSUED--------------•-----"_-_-- -•- ----------------- -------------------•--- DATE----------- ---------- DATE ------ Alterations and/or recommendations:"_.."_ ":"_.._ ----- ------------------ a . ------ ----•----.-- - ----------------------- ----------- •-------------Dat------- ------------------ ---�-- --- FINAL INSPECTION BY---------------------- --"V ------ e ---------------- " SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes} Oak Straet 132 Sycamore 5}reat 814 North "C" Street Stockton, California Lodi, California Manteca, Califareiet Tracy, California ES-9-2M 10.52 Revised W-2100