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a 3 APPLICATION FOR SANITATION PERMIT Permit No. .-..�, (Complete in Duplicate) / w� Date Issue � .�--fa -_--_ 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. 54 . JOB ADDRESS AND UDCATIO ! `----- -- _ - ------------------ - ----------- l�----- _- ------------------------- Owner's - -------------------- Owner's NaAT) q P -- ---•------------------------ . - ----- ------ PhoneAddress------ 311 -- ---------- _- Y-71 Contractor's Name------ --- ------ -• _-4•-- - -----___----- - Phone--_--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms Z_ Number of baths J___ Lot size -------- Water Supply: Public system ❑ Community system [I Private*r, Depth to Water Tablel.0 ff. Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam W Clay Loam E] Clay [-IAdobe El Hardpan E] + Z-_ Previous Application Made: of ❑ No X New Construction: Yes 4 No ❑ N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: D;^tance from nearest well��.0f_ _Distance from found ti n__ D LP M`erialj No, of compartments_...___Z-__._.._._-Size_-3_�_.ir� ;.Q_y_Liquid depth___ _____ _ ___ _ Ca acity-J"i Disposal Field: Distance from nearest Well--- __--Distance from foundation---A5--_.Distance to nearest lot j Number of lines________ :_ _ _.__ Length of each line______�� ________ Width of trench _Type of filter materialQDepth of filter material___I�___-_-_..___Total length__--1�Seepage Pit: Distance to nearest well_____________-_____Distancefrom foundation___________________.Distance to nearest lot line_____.____ .__❑ Number of pits---------------------Lining material---------- -----------Size: Diameter---- ------------- ----.Depth--- -------------- --- Cesspool: Distance from 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------------ ------------------- - --------- -------- ---------••------- I - Remodeling and/or repairing (describe)c________________________ _ _ ---•-----------•-----------------•--------------------------- ----------------------•--••----------------------------------•-----------•---------------------------•-•--------•---- ------------------------------------------------•--------------•-------- --------------------------------------------•----------------•----------------------------------------------••---------------- I hereby certify that I have prepay this application and that the work will be done in accordance with San Joaquin County , ordinances, St law d rules and r ulati sof the San Joaquin Local Health District. [Signed ----------- -------- --- -------------------- --------- ------ ---------•-------- ---------------------------------- --.(Owner and/or Contractor) ay:. ------------------• - --' ------- -----------------;-•----------------(Title)--------------------------------------- ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). s IF e I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------- --------- ------------------- -•-- ---------------------------------- DATE-------- - REVIEWED BY----------------------------------- -----------------------------------------------------------------------------•----------- DATE--------- -------------- ---------- ----------------- -- ---------•-•----------•-------- BUILDING PERMIT ISSUED---------------- --------------------------------- - ------ DATE----- - ----------------- -- ------- Alterations and/or recommendations:--------------- --------------------------------------------------------------- .__._ --------------------------------------• -------_--------------•--------•--------------------------•------•------------- --------•---------•--------------------------------- --------------- FINAL INSPECTI0 ••- ----- - ------------------------------ --------- Date-- '' LT SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manfeca, California Tracy, California E5--9-2M 10-52 Revised W-2100