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APPLICATION FOR SANITATION PERMIT Permit No. .__7.—_.fP___.. a.. -(Complete in Duplicate L Date Issued .____/_._.__ Applicaa-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 County O-r�dina�nce1 No. 549. � p JOB ADDRESS AND LOCATION J= /.j 4�j�[/ 1 ----- ---------------------------------------- --- ------ ------------------------- Owner's Name � �� G-:------- ��i7�r /Y Phone - -------------------- ------------------------------------ ------------Nt -��/=�--------- L-2 .r - ' - -- ----------------------------------- Contractor's Name.... _-- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial (- Trailer Court ❑ Motel ❑ Other ❑ ` Number of living units: e'___ Number of bedrooms _- Number of baths _ Lot size .. - _ ._.`3d-e________________ Water Supply: Public system ❑ Community system ❑ Private Irk Depth to Water Table 15� �ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe sR Hardpan ❑ Previous Application Made. Yes ❑ No a New Construction: Yes Q No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well________________Distance from foundation---........---------Material------------------------------------------------- 0 1 Z _-_---_______-_______----...._..__------____.❑ -Zof compartments--------------- ----------Size--------------- -_Liquid de th--------------- --Capacity --- Disposal Field: Distance from nearest well_________________D'stance from foundation-------------.------Distance to nearest lot line_______--_--•-__- ❑ er or lines-----------------------------------Length of each line------------------------•-----Width of trench------------------------•---------- Yl� of filter material-----------------__-.-_Depth of filter material-----------------------Total length---------------------------------.____---� Seepage Pit: Distance to nearest welL_�". ___-_Distance o foundation___-_ V--_--.Distance,�o nearest lot line____`_.. Number of pits----- ------------Lining material-�i --�r$i e!Diameter----.---,1-----.-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----------------- - --------- -----------------•----------------------------------------------------------------- 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, State and rules and regulations of the San Joaquin Local Health District. � - ------ ----- By -------------(Owner and/or Contractor)(Signed.) ------------- ----- -- ------ -- ---- --- By:•--- ..-- -- fir' ' j -----------------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--- ------------------------- -----------_---------- BUILDING PERMIT ISSUED------------------------------ ---- ------ ----- ------------------------------------------------- DATE. - 41 -) Alterations and/or recommendations:---------------- ---- --- -- -----------------------------------------------------------•----•----------- -----:%. ------------------------------------------------------------------------------------------- ---------------•---------- -----------------------------------•------------------•-- ----- ---- -- -- ----------- ----._...--•-------------- ------------------------------------ -- ---- - ---------- ----- ---•---- •------------------------- ---------------------------------------- � �- , FINAL INSPECTION BY:------ ---- ---------------------------- Date-- -- ,------- ---------•- --------------------------------------------- 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 145446 ATWCOD 12-54