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APPLICATION FOR SANITATION PERMIT Permit No. .__- _ � '.-.. (Complete in Duplicate) --------Issued b`-- - 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. •JOBADDRESS ANbb -"-- Owners Name------- -------- ------------------------------------•- ---- - - ----- -- ------- ------------------- Phone------------------------------------ Address..-----_--------- -----------------------••------•---Address--------------•-- e_, .1.._.. ��_-------`3-?._------------ ---------- --- Contractor`s Name------ .,:,(„------------------------------------------------------------------------------------------ ----------------------- Phone------------------------•---------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -�_---- Number of bedrooms _- ---- Number of baths -_.----- Lot size ------------------------------------------------_---------_ Water Supply: Public system ❑ Community system ❑ Private 2] Depth to Water Table ya_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: Yes ❑ NoN] New Construction: Yes ❑ No l' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-- _-._-------_Distance from foundation-------------------.Material--------------------------------.---------------. ❑ No. of compartments-------------------- - ---Size------------------------- -----Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest we!I_/`?�-.1'_ Distance from foundation--- .`--.-- -Distance to nearest lot line-l-Q--------- M� Number of lines---------/--�---------/-------Z--Length of each line__�P_._----_. Width of trench. --f'---------------_--_- �3 Type or filter material- N-/ -4----Depth of filter material sP --------Total length-iv'________________.____________-- i, Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits. - -----------------Lining material-----------------------Size: Diameter----------------------Dept'n-------------------- Cesspool: Distance from nearest well-------------- from foundation--------------------Lining material-----_----__--------__-,------_----- ❑ Size: Diameter---- -- ------------------------------Depth------------------- ------------------ -------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line--------------------------------------------- - ------•---------------------------------------------•---•------ -------------------------- Remodeling and/or repairing (describe):-- 'A� 4"� ,{`' ------�rO w= --------------------••--------__-•_••• -------••--/--------------------------- ---- -----------•--- ------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. ed) - , Owner and/or Contractor) ----------------- ----------------(Si n �----------------- By:---------------------------------------------------- - - -- -- ------------------------------------------ (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 APPLICATIONACCEPTED BY .. - ----------------- ---------------------------------------- DATE--- �-------------: ----------------- REVIEWEDBY------------------------------------------------------------------- ----------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------ ----------- ---•-- DATE. Alterations and/or recommendations:------------------- ---- ----------•-----------------------•-----------------•----•--------------------------------------------•------- -------- ------------- ---------------- - ------------ ------------•----------- FINAL INSPECTION BY:-, .4fa' ----- --- Date-.._- -'f•��-' '7 ----------------- --------•---- ------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreaf Stockton, California' Lodi, California Manteca, California Tracy, California E5-9 145446 nrw000