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„JJ ti APPLICATION FOR SANITATION PERMIT Permit No. ..... ................. 44 (Complete in Duplicate) R � I 0 Date Issued _...7 e¢-aT lication 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 AND OCA I -- -, ` -�--- -- -------------------------- ------------------- ----------------------------------------------------------•-------------- •- Owner's Name-- - -- - -------. ---- ------ --•----- - ------------=-------- ------------------------------------- Phone..................................... Address------------ -- -- -------r------ --•-- --- --••-----•--•-----•-----------•----••---------•--••---••---•-----•. -- . ••............................... Contractor's Name -----�-d-illS------------------------------------------------------ Phone _-- f��P. Installation will serve: Residence E� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑y Other ❑ Number of living units: .,/____ Number of bedrooms _2-: Number of baths ---/.. Lot size -----�,�-. 20--0-------------_.......... Water Supply: Public system [g Community system ❑ Private ❑ Depth to Water Table _4J�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,[ ( Hardpan ❑ Previous Application Made: Yes ❑ No Q�_ New Construction: Yes ❑ No 21 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tanhye from nearest well-----------------Distance from foundation....................Material------------------------------------------------- ❑ ' No compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Fi Id- from nearest well-----------------Distance from foundation----------------....Distance to nearest lot line................. ❑ �Nur of lines----------------- ----------------Length of each line------------------------------Width of trench....---_-____________-___.___..--__ Type of filter material-------------------------Depth of filter material-----------------------Total length........................................ Seepage Pit: Distance to nearest well----A&)-al istance from f9,undatio _-_-./-/.a....__..Di tance to nearest lot line.... [ Number of pits-------1-------------Lining material-_C-_. Depth_ ___________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 0 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 certif at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, nd rules and regulations of the San Joaquin Local Health District. (Signed) '_--- - ---------------------------- ------ --------------- -- --------------------------------------------------------I-----------(Oper and/or Contractor) By:.... ------------ :..... Gtr --- - --------------- --------------------------------(riifle)------- ---- ------------------------------------------- (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..____. REVIEWEDBY------------------------------ = --------------- DATE-- .................................. BUILDING PERMIT ISSUED-------------------- ------ --------------------------------•------------------•-------------------- DATE------------` -- Alterations and/or recommendations---------------- ----------------•------...--------•-------•--•-----------•-•--••-•-••-•---. --•--------•----•- - -------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•--------------- ---•--••----•---------------------------------------------------------- --------------------- --------------------------------------------------•----•---•--••------------------•••-----•---•...-----•-----.--••----- .._. -------------------------------------------------------•----------------------------------------------------------------------------------•---------------------------------------------------------------------------••---- --------------------------------------------------------------------------------------------------------------------------------------------------------------------Y_........._._...__.___...._.__......._......__..._..... FINAL INSPECTION BY------------------- --- --------- Date------(5_------- --------- ---------------------------------------- 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 ES-9-2M ; IRevised W-2100