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APPLICATION FOR SANITATION PERMIT Permit No. . _. (Complete in Duplicate " ' Date Issued Application is hereby made to the San Joaquin Local Health { 7 - 09c)-j!7 This application is made in compliance wjth County Ordinance No. 549, _ .� h District for permit to construct and install the worherein described, JOB ADDRESS MD' CATION/> - Owner's e• R _ - Address . ` `� - �-�" - ------- -- � - � - --------------- ------------------------------------ Contractor's Name______•_ _•__ ` ------------------------------------------------ Installation -•-------- -------•--------------------------- Installation will serve: Residence A Apartment House ❑ Commercial / ----------------------------------------- Phone•------•- ------• ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -__-___- Number of bedrooms _______ Number of baths Wafer Su ________ Lot size ----------_-------------------Supply: us stem 3 PP Y' Pblic Y ❑ Communitystem system Private M Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand Previous Application Made: Yes ❑ Gravel ❑ Sandy Loam (] ClayLoam r--� ❑ Clay ❑ Adobe ❑ Hardpan ❑ -� ❑ I No ❑ New Construction: Yes ❑ No ❑ `v 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__�.D" --Distance from found tion___ Z No. of compartments.. ��jj Q - -M �eri t - Size-_ sQ-� Li uid th__ t - -� Disposal Field: Distance from nearest well----�� - 13- ----------Capacity-- -____.__._.Distance from foundati __-Distance to nearest lot line__ Number of lines-__--.� T ---""-- � "' ._ f 1-ff------- --_Length of each line¢' � "" �/ti/idfih of trench_ re Type of filter material_- ._„f�. Depth of.filter material__ Seepage Pit: Distance to nearest well----------------------- -------------Total length___./-3-a ------------------ ngtrialDistance from foundation___________________Distance to nearest lot line------------❑ Number of pits----------------- "--.Lining mafierial ______-"_"" "---Size: Diameter___._-___""-- ' Cesspool: Depth------------------- - p Distance from nearest well-_ -------------------------------- El pistance-from foundstion__"________-_------Lining material__________ Size:.Diameter---- =----------= - ---- -----<Depth-------------------------------- -- - ----------- ----9-----� `�J Priv . -� --- -- _ _ _ --------------------------Distance from nearest building , -. ❑ Distance to nearest lot line------------------------ - g----------------____-- ---------------------------------------------------------- emodeling and/or repairing (describe)__________________""__-- -------------- ----------------------- -----------------------------------•----------•---•--•------------------------------•-----•----- ------------------------•--------- - - -- - - - --- -ed__------_a ----------•------------------------------------------------------------------ ------------------------------------ Ihereby certify that I have prepared this application and that the work will be done in accordance wif- San Joaquin Coun ► ordinances, State and rules-and regulation/of the*San Joaquin Local Health District. -- --- - ---- ------------------------------------------------------------------------------------ 8y:.__.-____-.____"__-• - """ f � caner and/or Contract (O d/o °r)� --- ----•------•--•-----------•------------------------------------- _ (Plot plan, showing size of lot, location of system in relafion to wells, buildings, etc., canbeplaced on reverse side). -- ----------- FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED __-_. .__y �"� - REVIEWED BY ------------------------ - - DATE_ = -- - S -- ----------------- UILDING PERMIT ISSUED------------------------- ---- --------------- ------ ------ -- ------------- ---- DATE. ------------ ---------------------------- terafions and/or recommendations:---- ' DATE- ------------------- I ----------- ---------------------------------- --- ---------------------•--•--------- X pat . -------- ------- FfNAL INSPECTION BY:_.�_.-��'��"�----- -------------------- el/ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California y 132 Sycamore Street ES-9-2M 10-52 Revised W-2100 L 814-North "C" Street Lodi, California Manteca, California Tracy, California