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APPLICATION FOR SANITATION PERMIT Permit No. ._. - - `... (Complete in Duplicate)jk/�\\ Date Issued 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 Count. Ordinance Na. 549., JOB ADDRESS A D LOCATION. �{ j`j�! ��A �` -- Owner's Name--- � ,�s. :te Addresstl�l � °� r !,�t ---------------------•-------------------------------.....----......-•------------------••-------------------------••- Contractor's Name -----. Phone----------------------------------- de Installation will serve: Residence ❑P 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 ElPrivate Depth to Water Table -- ft.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ fldobt Hardpan ❑ Previous Application Made: Yes ❑ No P 'New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank Distance from,nearest well-_�_I-D. Distanc fro fo nd ion----/6?---___.,M t rial----- -:__.. Liquid depth----- -- `� Capacity..--- -®----__-•-• No. of compartments-----,�--------- --Size-- �_. ._�_.:.-- - - ----------- Disposal Field: Distance from-nearest well_AU -Distance from foundation.----1__Q.--.Distance to nearest lot line_ Number of lines-----------I------ Length of each line------------ -�_ r--Width of trench--------A-, - --------------- Type of filter materiai_____S.�i cD0pth of filter material---._o;L0-_.....Total length-------.-_-/. In----------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line----------------- El Number of pits'--_�'--------------Lining material--------------- --------Size: Diameter---------------- Depth--------------------------------- Cesspool: ---------------------- ----- 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---------- - Remodeling and/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�e , State awA and rules and regulations of the San oaquin Local Health District. ii --------._-___-_--------------------------Owner and/or Contractor (Signed). .- -- -_2 � � ---------------- ( ) 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-------- ------- ---------- ----------------------•- ----------------------•---------- DATE----- - • �j - -- --- REVIEWED BY---------------------•----------- --------------------------- ------- ----------- - ----- --- --- -- DATE----- --------- BUILDING PERMIT ISSUED------------------------------------ • . - QATE Alterations and/or recommendations:------- - -----•------------- --- --------------------------------------- -------------------_ •--------------...-..---------------------------- ----- r -------------------------------------------------• ----------------------- • ---------------------------------------------•-------------------------------------.-------------------------------- ------------------ --------------------------- ------- -------=-------------------------------------------- ------------------------• ------------------------------------------------------------------------------------------------------ --------- --- FINAL INSPECTION BY.... ---"- ---- -••------ - =---- - -•-•-- ----- ------ Date .. . J _.:n --- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americbn Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES—S - 145446 ATWOO6