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APPLICATION FOR SANITATION PERMIT Permit No. .. ~�.Q. __.. (Complete in Duplicate) Date issued Applical-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. JOB ADDRESS AND LOCATION Owner's Name /` Q5---------------- ---------------------- -------------------------- ------ Phone--- "�------ ------------- Address......------J.-Z '• ------- -----------P-/ j'��--•------------•--•------------------------------------------------------------------- -------------------------------------- Contractor's Name---------- - ---------------------------------------------------------------------------------------------- Phone.....-- '----------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_- - Number of bedrooms -__umber of baths "L_ Lot size .___- _ 1_ ________________________ Water Supply. Public system A Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 0- New Construction: Yes IK No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest we'I---Y1�DWLQ Distance from found9fion---,�p____-___.Material.... ____ ._______ -_ kj ® No. of compartments----_-�--_+---------------Size-------�-3�„___��_--Liquid depth_-----if---------------Capacity../I60�_-----. Disposal Field: Distance from nearest wellV)0$ lam_._Distance from foundation---/?----------Distance to nearest lot line-------- Number of lines------ __________�_j-----------Length of each line---- __ ___ ---------- Width of trench- Z a_____________________ Type of filter material__S 77&1� -----Depth of filter material___/ -------------Total length_________�i�-------------_ Seepage Pit: Distance to nearest well-.976-?W _ - __Distance from foundation---.______--------Distance to nearest lot Iine�__ +'±? Number of pits----- ,...........Lining materiaSize. Diameter-----------------------Depth_---_,:?--s-__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-_--_._____._______________________ ' ❑ Size: Diameter--------•-----------------------------Depth--------------------------------------r-------------Liquid Capacity---------------------- -----gals. Privy: Distance from nearest well----------------___--------____------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line --- -- ----- -------------------------------- - --------------------------------------------------------------------------------------- Remodelingand/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 regulations of the San Joaquin Local Health District. (Signed)_ --- --------------<L>L 1n --------------------------- -------------------------------------------------- •------ -----(Owner and/or Contractor) i - ---------------------- - By:--------- •----••--•--•..............•--------------------------------------------------------------------------------------•----(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---------------------------------------------------- S- --- --------------------•---------- DATE----------;�- G � REVIEWEDBY--------------------------------------------------- ----------------------------v.-. --------------------------------------- DATE---------------------------- BUILDING PERMIT ISSUED--------------------------------------------------- -------------------------------------------------- DATE------------ ... Alterations and/or recommendations:--------------------------------------------------------------------------------------------------•------------------------------------••-•----------•-------- - _`'------- 1 ---f- - - 1,,_ -- FINAL INSPECTION BY: ----------------------------------------- Date-----I --- j SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9---2M ; Revised W-2100