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APPLICATION FOR SANITATION PERMIT Permit No. .-` ---- - (Complete in Duplicate) Date Issued '_ "" -`�� AppleY cation is hereb made to the San Joaquin Local Health District for a permit to construct and install the work herein dedcribed. This application is made in compliance with County Ordinance No. 549, s JOB ADDRESS AND LOCATION-------= / I------- �� --------� � ------ ,1 t �.. 7C1 �'L Phone------------------------------------ Owner's Name------------------------------------ }�, Address G� " --•------------•-------------------- -----•----------------•-••--•- --------------------------------- Contractor's Name.------- --- -- d Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units. _��____ . umber of bedrooms _� Number of baths --1__- Lot. size _._.•__.______.__�4 _ _ _______ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- 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 kNo ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well__ Distance from foundation__. O. Material ___ ---------------- X t�h _Capacity_______ C�C� No. of compartments-----rY-----------Size----._�, dN . Liquid depth-------- --------------- - O is osa Field: Distance from nearest well__ stance from foundation.____------/9 to nearest lot line_____r�r__. Len th of each line___-______� ------- Wid#h of trench___________y � Number of lines---------- 9 - r{- g pp ��._________._ Type or filter material ! _ __ ________ epth of filter material__--------lL�--------Total length ---------------- Seepage _- Seepage Pit: Distance to nearest well----------------------Distance from'foundation--------------------Distance to nearest lot line------------------ F1 Number of pits.----------- Lining material------------------�---S:ze: Diameter------------------ ----Depth-------------------------- Cesspool: Distance from nearest well-------_---------Distance from"foundation-____.___--___.___.Lining material__---------_____________--_ - Size: Diameter-------------------------- - ..Depth-.-------------�s`- ----- Liquid Capacity gals. El Privy: Distance from nearest well {___._--________-------------------------Distance from nearest building----------------------------------------- 0 Distance to nearest lot line----------------------------------------------------------------- ------------------------------------------------------------------ Remodeling and/or repairing (describe):---------------- -------------- ---•------------------•------------------------......---------•------ ------•----------------------------------------or--------------------------------- -- -------------------------•--------------------------------------------•---------------------•----------------•-------------------------------•-•----------------•-------..--------------- 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 regulations of the San Joaquin Local Health District. (Signed)--- ------- - ---- ---- ------------------- � (Owner and/or Contractors sY� -------------------------------------------------- �, 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 APPLICATIONACCEPTED BY--------- ------------------------ -------- ---------------------------------------• DATE---------- REVIEWEDBY---------------------------------------------------------- -------------------- DATE------------- ------- BUILDINGPERMIT ISSUED---------------------------- - --------------------- DATE--------------------•------------------ ---------------- Alterations and/or recommendations:----------------------------- ------------ -------•------------------------•-'--------.--------.......-----------•-------------•------- :---------------------------- ------1 .-. - --------------� ,------------------------------- 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 Revised W-2100