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APPLICATION FOR SANITATION PERMIT Permit No. -- (Complete in Duplicate) Date Issued/=j5--Z-V—' Application Application 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. r Q 1 A LOCATION_ L' / - .iii_.. -- C74-f.�r�C�-----------------� JOB ADDRESS -- - ------- ------------------------- ------- Phone--------------------------------- Owner s Name___ - - Address---------------f:L_ ._3_0------------ - ----------------------•--------••-• .. Contractor's Name--------• .--- - - Phone-------------------------------- Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ _iMotel [I Other [I { Number of living units: ______-Number of bedrooms .____p' Number of baths _ /- --- Lot size -----L - -�'---------------------------- Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table 4ft. Character of soil to a depth of 3 feet: Sand E] Gravel [ISandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IX Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w .2 Mater Sep is Tank: Distance from nearest well___,�_0----Distanc frorp foynda�jon_____ ____________ Capacity.___ d-------- No'of compartments__._.----�-------_-__Size-__ -1� -, ---Liquid depth__._______ L �• I Disposal Field: Distance from nearest well...._i�.d.....Distance from foundation____�-.? .._-_--Distance to nearest lot line-- ____ ___..- Number of lines---------------1Z-o--------------Length of each line__719_71 ,1�------Width of trench--.-��j� -------------------- Type of filter material ----Depth of filter material_____-_�_._ Total length------j�gn�---------------------- Seepage Pit: Distance to 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._ - Distance from nearest building Privy: r _. , Distance from nearest well------------------------------- - g------ ------------------------------- --- frt- - ❑ Distance to nearest lot line------------------------_-------------------------------------- ------•---------------------------------------------------- ---------- --------------- --------- Y s �-�------�--/---.-- -- l = -- Remodeling and/or repairing [describe]:_>�—�-- '�'�'`� ---------------•---------------------- -------_ ---------------------------------- I ------------••----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reguiationsmof the San Joaquin Local Health District. ------------------------------------------------------(Owner and/or Contractor] ` (Signed)' {Title) By:----------------------------------------------- -- - - ----------------------------------------- ---- ------------ (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 --------.•-----____-- --- - - -------- -- --- REVIEWED BY----------- --- -- DATE i: __ _,—= - ----------------------------- - ---- --------------------------------------- BUILDING PERMIT ISSUED--------------•---- --__---_ - = "� D7�TE�' -----1------------------------ ----�> —Alterations and/or recommendations:------------- - ---------------- -•------------------------------- ------------------ --------------------------------------------------- ------------- - FINAL INSPECTION BY: - ---------------------- ---------- - ------- Date_. ------ ------------------ - ----;�------;;�4 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 FS-9-9M io-S2 Revised W-2100