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(L -� APPLICATION FOR SANITATION PERMIT Permit No.2__(---- 3 ' (Complete in Duplicate) a�, Date Issued ______iI--l_�. pplication is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described. 9 p ; This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TIO ---------- -- -��----- Owner's Name--------------------- ---- --:`� �---------- --� '------------------------------------------ Phone------------------------------------ Address---------------------------------------r--=-----------•------------ --- ---------------------------------------- Contractor's Name--------- ------- ---w--------------------------------------- Phone----------------------------------- Installation will serve: Residencepartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: _��ysfern edrooms __i____ Number of baths __I___ Lot size ------- � ____________________ Water Supply: Public system ❑ Private ❑ Depth to Water Table -------- ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ SandyLoam ❑ Clay Loam ❑ Clay ❑ Adobeardpan 0 Previous Application Made: Yes ❑ No ew Construction'. Yes ]] Noo D--" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) NJ41 Septic Tank: Distance from nearest well--------.--------Distance from foundation----------------___.Material-------------------------------.----------------- ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-------------- ------ . Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_____-___________ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material______,�// _,____ _ _ ________---_Depth of filter material____ ____________ ___Total length------------------------------------------ S pa e Pit: Distance to nearest wellf4- _Distance frQ_rrl foundation----_e_�a____ .Distance to nearest lot line___ Number of pits------._-----------Lining maferialSize: Diamet _ Y,_J_),_)0_.Depth------------- Cesspool: Distance from nearest well-----_-----------Distance from foundation--------------------Lining material------------------------.____________- ❑ Size: Diameter----------=---------------------------Depth-----------•----------------------------------------Liquid Capacity----------------------------gals. � -;ter.- -a ., .. ,�. " „�.. _. 9 n ff �. _ . Priv-y:""�""�'�- Distance from nearest we41_____. ._"-�. -. __-_-_"- ___ __-_"-Distance from nearest builcJing ________�-------------------- 13 _.._- _".__, ._. k ❑ 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,kfate laws, and rules and reg --- ----------------- ------- ulati. ns of the San Joaquin Local Health District. , -- - - .(Signed)•---------------- - a �-- ------ -- - -- -------------------------------------------------(Owner and/or 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 DEPA TMENT USE ONLY APPLICATION ACCEPTED BY------------------------- ----`----------------------- ------------------- DATE------------ . ---i---��-------------- ------------ REVIEWEDBY------------------------------------------------------------------------------------.---------------------------------------- DATE BUILDING PERMIT ISSUED---------------------------------- ----------------------------------- ------------------------------- DATE Alterations and/or recommendations--------------------------------------------------------------------------- -----------------------------------------------------------------------•--- -------------------------------------------------------•--------------- - ------------------------------------------------------------------------------- ------------------------------------------------------------ I 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 851 Revised W-2100