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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued Applica-l-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 Ordinance N . 549. JOB ADDRESS AN LOCATION------- - a S C, -----------------------••------------- -•-------------....--•---- ---------------------- Owner's Name Phone. ---------------••- - - -- - --------------- --- ---- ---- --------------- -- - ------------------------ Address-... . -- ------" — Contractor's Name-..----- Q - r - Phone ------------ --------------------------------=--------- ./- - -. Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: /--- Number of bedrooms --.2- Number of baths /-__ Lot size -----SQ � 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 E-_Pardpan ❑ Previous Application Made: Yes ❑ No [Z]_ New Construction: Yes ❑ No [t om TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pt�'cTank: Distance from nearest well-----------------Distance from foundation------------------- Material-_-------_--.--__..--__.----.-_ � ------------------ IJo. of compartments __Size - --------- ------_Liquid depth-------------- --------Capacity I- eld: 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---.-._-_-_-_-_-_-.-_-_-_-_-_-.-_-.-_-_-_-_-_--_-_-_-- -- - -- Seepage Distance to nearest weff�-_-_�'..f-'�_Distanc m fo ndation_:c? -___.Distance to nearest lot line.- e.�___ [ Number of its.--__ ? '� / p p -�----------- Lining material- - �C---- ----Size: Diameter---�`-3 --------Deptn-----o�s."'------ �! ----------- Cesspool: Distance from nearest well--_---__----_-Distance from foundation....................Lining material--------- G� ❑ Size: Diameter-------------- -----------------------Depth--------------------•---------------- --------------Liquid Capacity..---------------------- gals. l Privy: Distance from nearest well____________________ .-.__Distance from nearest buildin El Distance to nearest lot line, Remodeling and/or repairing (describe)---------------_-.-...__ ---------------------------- --------------------------------------------- ---------••--------•-------------•-----------•------------------------•----------------•--------------------------•------- ------------- I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, Statpland rules and regulat'ronbf the San Joaquin Local Health Distric+. (Signed).-------•---- •-... .`---- . ..... - _•...�..1,� .- , ------�`—�--•--------------- --• ----------------- --- ------��.�f Owner and/or Contractor) By:------------------------- --- ,Wit!'--_----- (Title)-- z - - ----------------- (Plot plan, showing size of lot, locat' n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....... -- ------------- DATE........ REVIEWED BY-------------------------------- ------- DATE------------------ BUILDING PERMIT ISSUED------------------ --------------- - DATE---------.- _-- Alterations and/o�o mendations:-�-..t-� --- --•--- _- - �` / --- ------•-••--------------••----•-•-----•\-------•-----••--------•----•---------- ---------------- ---------------------- ---------------------------------- ----------------- - 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 Traty, California i ES-9 145446 ATWOOO