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APPLICATION FOR SANITATION PERMIT Permit No_�..0----------- (Complete in Duplicate) P } '� '"z� Date lssued ----------------------- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein-describgd.:. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO f1Tl -- --------------- - --- ----------- •_- 1--------- ------------------ _' / Owner's Name = - ----------------- -------------- Phone---- -------------- Address------- -------------------------- r _. ... ..(��..�. --------------- -------- ---- ----- --I--------------------- -- ..... Contr o Name---------~� (- $ ` - - --=�- `-------------------------------------------- Phone: : -�- +a Installation will serve: Residence Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 04 Number of living units: _.{'__ Number of bedrooms ___`* _ Number of baths . __ Lot`size Water Supply: Public system ❑ Community system ❑ Priva!�KDepth to Water Tabl, ft. Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Aclobplj�f Hardpan ❑ Previous Application Made: Yes NovElNew Construction: Yes No E]TYPE OF INSTALLATION AND SPECIFICATIONS: // \\ (No septic tanVoir cesspool permitted if public sewer is available within'-200 feet.) Septic Tank: Distance from nearest well-_4504 Distance from oundtion _.___--__- -r),. '-------- Mat ::_ -x - __ _ No: of com artments_._Z_._. _Size_ �._.Liquid de th-_-�_ _ - Capacity -- - --- _ G--f Dispo al Field: Distance from nearest well._.y j�__`__Distance from foundation_ __ -----------Distance to nearest lot'line__,.�______._... NumberOf lines__________________ __ _______Length of each line_______ (U__r_________.Width of trench. __�_'.__._-_..________ T re of filter material__ -- t yp -- _-- _ r__-Depth of filter material..-,�.�.-.`--�-(.Total length -tom-------------------- --- !------:-----f-- Seepage Pit: Distance+to nearest well___ _ `_- ___ ,.� � _____Distance fr m fou dation_____: ___�-�____.Distance to nearest Kline____ ___ ______ Numbed"of pits------/-----------Lining materia�� .Size: Diameter--- -------Depth -.--------------- ` C sspool: Distance from nearest well-----------------Distance from foundation--------------°.___lining material_-_______._____._______._____--____ 7 ❑ Size: Diameter------------------.--------------------Depth----•------------------------------ --------------.-Liquid Capacity----------------------------gals. Priv Distance from nearest well_________________ .____.__-Distance from nearest building ❑ Distance'to neareWlot line______________________ Remodeling and/or repairing (describe):__ y - ------------ -- -- - --------- ------------------------------------- -----•-•--••-----------•----•-••--•-•-------...--------------------------------------------------------••------------------------- -----------------------------•-------•---.---.----------------------.----.-------------••------------------------------------------......---•------------•------------------------------------------------------------------- -------------------- ! hereby certify thea I have prepared this application and that the work will be done in accordance with San Jo ggwhi aunty ordinances, State laws, an es and regulations of the San Joaquin Local Health District, t {5i ned i 9 } _ - -- ----Owner and/or/Contractor) By:-----------------_-=- --------------------------- ------ --�` =----- -- -----3 ------- •--- ------------Title------ _7�_ (Plot plan, showing size of lot, location o stem in rela ion to wells, buildings, etc., can be p acep on reverse side). I FOR DEPARTMENT USE ONLY tea' APPLICATION ACCEPTED $Y- ----- -------------- - ---- --•------------ -----••--••------------------------------ DAT -�'�+ -------------- - TAT REVIEWEDBY - ---------------------------------------- DATE... 71 ----------•--•--------------------------------- BUILDINGPERMIT ISSUED------------.---------------------- -----------•------------------------------------------------------ DATE--------.. ... Alterations and/or,recommenda.tions------------------- ---------•--------------------- -•-----------------------------•-------------------------------------------------------------------- ------- -------------------------------------------------------••-•----------•------•--------•---------------••------•-- ---------------------------------------------------•-------•--•----'-------------------------------------------------------•- •-----••------•-..•--•-----------------------------------------------._- ! -----•-•----------------------------------------------------------------=--------•-----------------------------------------------------------------•-------•-------------------------- -----------------------••------- 1 -------------------------------•------•---------------- FINAL INSPECTION ---------------- Date---------------- ------------------------ ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street X 7132 Sycamore Street 814 North "C" Street, 1 Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M ; Revised W-2100