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0 APPLICATION FOR SANITATION PERMIT Permit No.., ---- --- ------- s (Complete in Duplicate) Date Issued 1 r ti cal Health District for a permit to construct and install the work herein described. Applica+ion is hereby made to the San Joaquin Lo This application is made in compliance with County Ordinance No. 549. t # JOB ADDRESS AND CATION--!---- - ------------------------ - - - --------------------------- --.------------------------ -- -------------- Phone_ ------------------ Owner's`Nam Address. -- Phone. _ ....... Contractor's Name_______________ I Installation will serve: Residence Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other El I ► 2 t i Number of living units: __.-,,�_ Number of bedrooms - Number of baths __`'___ Lot size t!.� ----•• Water Supply: Public,system Community system El `Private ❑ Depth to;Water TableA001Q._ ft- I ' Character of soil to a depth of 3 fee+: Sand 0 Gravel F-1SandyLoam El Clay Loam E] Clay ElAdob9A Hardpan ❑ k I Previous Application Made: Yes ElNo New Construction: Ye No E] . TYPE OF INSTALLATION AND SPECIFICATIONS: !; (No septic tank;or cesspool permitted if public sewer is available within t 200 feet.)... l Septic T k: Distance from nearest well------ from foundation____- -_x___.-___ _.Material----------------------------------------------------- No'. ______________________ ____________________-_-__No. ofcompartments---------- ---------------Size--------------------------------Liquid depth-----------------:- -------Capacity------------------- . ------------ i,e,.119 _____.Distance to nearest lot line________________ Ditance from nearest well_-_.__-__ _----.Distance from --------------- Disposefoundaton Fie _ Number of lines----------- -------Length of each liner-----=- --------- ----Width of trench----------------------------------- �..Type..of filter material-f_=:--- Depth of filter material------------------------Total length-------------------------------------; Seepa a it: Distance to nearest well`--=Distance from fo ndation__�lf___._.__.Dt�r;ce to nearest lot line----------------- Seep -r_;_______.-_ __Linin material, _ -----Size: Diameter___-� Depth------- ---- - Number of. i#s___ - g "";--- Cesspooll Distance from nearest well-----------------Distance from foundation-------------------_Linin.g material__--.___-____-_____--____________-- Sizo: Diameter # Depth----------------- ------------ `-;;_----- .............Liquid CepacitY------------------ gals. ❑ a -- . Privy: Distance from nearest well---------------------- ------'�` -_Distan"ce from nearest building-------------------------------- .1 . ... ------------ .. ...-..Distance to nearest lotiline-------- --------- ----------- -- --- --- ---- y I F ., Remodeli g nd or repairin descrit):_ ------ -- --- = - ---- s -- - ----- -:----- - -•-•--------- -------•---------------- _ ------------------------- ------------------- ---------------- -------------,... - _ --•-•----- ---1- -- ---------- ------•------•--------- _... ',.� -------------- : hereby certify that 1-have:preparedA is application and that the work wiil,be done in accordance with San Joaquin County ordinances, State , and ed reg Eo.s of the San Joaquin Local Health District. r Si ned --------------------------- = caner and/ ( 9 , )-------- _ or on t (Title rs-- - ----- -- (Plot plan;sho size of�lot, location of system in relation to wells, buildings, etc., can be p on reverse side. 9 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------- ---- - -------------- DATE------------- -�-----) - ---- ------ --------- �7 REVIEWED BY------------------------- ---------- ------ ----- ------------ ------- -------- ------------------------------ ----- -- DATE-----------------------------------•---------- ----------ro - BUILDING PERMIT ISSUED----------------=-----------•- ---••---------------------------- Alterations and/or recommendations:-`--------------------------=----------------------------------------------m-------- -- -----------•----------------------------------•-- _ - L ___________c ..___ ____ h ---------- tik ef _ `----------------------- � -------- --- r FINAL INSPECTION 'BY:_:____-__--------------- •- Date---------- ---------- I 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 i ES-9-2M ; ' Revised W-2100