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APPLICATION FOR SANITATION PERMIT Permit No. ��T'- --- ►�1 (Complete in Duplicate)a Date Issuec��' Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install theworkherein described. This application is made in compliance with County Orclinanc o. 549. JOB ADDRESS A LO TIO I j ��4 ------- -------------------------------•--------------------------------- r, ----------- t. Owner's Name - - ' t ----------------•---------------------------- -- - ------•-----------=-------------------- -- - Phone----•-----------r- ---•- ---------f-- -Address- --•----Contractors Name----J?--4--- •- Phone-- --------- ---------- Installation will serve: Residence E--Apartment House❑ Commercial ❑ Trailer Court❑ /Motel ❑ Other ❑ 'Number of living units: ---�--_ Number of bedrooms _2--- Number of baths --//--- /�----- Lot size __-_ _A...... ------L-'-Q---------------- Water` Supply: Publicsystem' ommunity system ❑ Private ❑ Depth to Water Table-4"-'�. ft. { Character of soil to a depth of 3 feet: Sand ❑ Gravel.❑'_Sandy Loam ❑ Clay Loam❑ .Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No h'New Construction: Yes ❑ No t 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) Septic•Tan : Distance from nearest well---------------_Distance from foundation_---_-_--------- .Material------------ :__-----_- No: of compartments--------------------------Size-----------------------•------•-Liquid _ _depth----------------- Capacity---- •----------- . y - f isposel Field: Distance from nearest wel10714d4`4.--Distance from foundat/ion--------- ---�....Distance to nearest lot line._'. ..---...-. Number it lines---------- -- -r T_,-t-- Length,of each line---Zd 40----- -----------Width of trench-.-. - -:--.----------_----_ f ,_ E Type of filter material-,C- ---- 7T-:Depth, f`filter material---.-- ---/"-.--Total length__------- _----__------------- Seepage Pit: Distance fo nearest well-'_---------------Distance from 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---- ---------------- --=......%=-° = y-• = ="_` -- "- c: _ Remodeling and/or repairing (clescribe}:_.--- .�t „_--- --------------=--- --------------------------------------------------------------------------------------------------------------------------------------------- --------- ---•----••---•------------------- -------------------------------------------------------------•-----------------.--. ---------•---. ------------------------•-----••--•-•_---------------------••---•---------------------------------------------------- -- P - - - ---------------------------------------`----------•----------------------•-••-•-------'•`•••-----•-•-------------------------•---------------------------••••----•-------------" ----------------- I hereby certify that I have prepared this application and that the work wilt be done in accordance with San Joaquin County ordinances, St laws'and rules a d regulations of the San Joaquin Local Health District. (Signed) - ---------------- (- rter-a c Contractor 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-=---------------------------------- REVIEWEDBY -------------------------------- ------------------------------------- DATE—9-t -------'-•------ BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------------- DATE------ - Alterations and/or rercommendations:----= --------------------------------------------------------11-1------ --------------------------------••-------------------.........--------------------------.-:•u------------------------------------------------------------- ------------------------------------------------- ----------------------------- -------------------------- -----•----------------------- - r FINAL INSPECTION BY:-_'.: _/ -s-----_---------------------- Date. JJ - 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 E5-4-2M ; Revised W-2100