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APPLICATION FOR SANITATION PERMIT Permit No. .. 3 ____.: (Complete in Duplicafe) Date Issued Applica�lion 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 Or inance No. 549. JOB ADDRESS AND LOC�jATION Owner's Name f= ' ---•------------------- ------ Phone------------------------- ' - - - --- f.... Address----------------- Contractor's Name_______________________ Phone.-!<_, -- / ' ---- �.. Installation will serve: Residence Apartment Houseomme`rcial E] Trailer Court E] Motel p Other ❑ Number of living units: ___ .. Number of bedrooms -�: umber of baths __I_ Lot size _- __------------------- Water Supply:pp y: Publicsystem ®Community system ❑ ,.Private ❑ Depth to Water Table ft- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel'❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&�Hardpan ❑ Previous Application Made: Yes ❑ No � New Construction: Yes ❑ No [fir TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL______w.__ --_Distan`,efrom foundatian----,1 .____.Material_.___---__-- r . ---------------- No. _-- ----_. No. of compartments-.------,?---------------Size__•.�_s?- - ----Liquid depth----- .� -•- ----Capacity_.-- - -�/�-•-- DisposalField: Number from lines earest ell__A_� Distance from foundation✓_p--------Distance to nearest lot line__.f�__..._. - - Length of each line________ --. fff'a �F ._.Width of trench �� Type of filter material----- of filter material------/-._...____Total length----C6_rG? --__________ ------- �, f . Seepage Pit: Distance to nearest well___. /-Distance from fou ation....................Distance to nearest lot line_,__________-____ Number of pits--------/------___Lining material_-4 M Size: Diameter___, -�� __Depth.....�2 .......... 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----------------------------------------- 171 Distance to nearest lot line----- ------------------------------------- --------------- ----- Remodeling and/or repairing (describe):______.__._ -__ -------- T7 r ------- ________ _-_•_•_______________•__••____.______•_____-...------------------------------ j�--•----- -----------••-----_ -------- --------------- ---------_----------------------_----.,_____---_-_.__---_-_-__-__________--________________-___________-______-_____-_____________.__..___________-___________._._-_____-_-__--_____.____-_--__..___.__-________._______._._..- I hereby certify thaf I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulafions of the San Joaquin Local Health District. f e_ ------ (Signed) ----------- {� Contractor)_.'''_... BY• ._ �' '�---------- ------• ------(Title)------- - - -------------------- (Plot plan, showing size of lot, locati of system in relation to wells, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ........ ------------- ------ DATE------------- ----------------- D BY-------- -------------------------- ------------ -------- ---------------------'-----------f----------- DATE-- BUILDING PERMIT ISS UED=---=-------- ••--------------------------- - DATE. - ---------••--------------- ----------------------------- Alterations and/or recommendations-------------- ---------------------------- --- ---•---------------------------•---------------------------------•-------..._ ----------------------------- ------------------------------ ----------------------- r1® �`' ----------- ----------------------••---------- --•-•- --------------------------- ---------------- ---------- ---------------------------------- -------------- FINAL INSPECTION BY:..---- -----------•------------------- Date---- --_ 3.r `/ r 5 - )SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 arwaoo -54