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APPLICATION FOR SANITATION PERMIT Permit NoAlf__7_._____ (Complete in Duplicate) �y/ Date Issue dl�-.�_/=_______ Application 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 No. 549. r ,q i irp JOB ADDRESS AND LOCATION... -._________ __ '�-*'"-t.___ � Owner's Name-- - -------- - ---------- ---------- --------------------------- Phone_ /-- -- Address---, —------------------------- ---------------------------------------•---------------- ----------------------------------------------- Contractor's Name... "' --------------------------------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms _______ Number of baths -------- Lot size ___-2______- ---------------------------- Water Supply: Public system 9 Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑i Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes d' No-9 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Sep ti-Tank: Distance from nearest well--__A,17-0____Distan e �' foundation_____/ ________________.__ ____.___.___.________... No. of compartments----------- ------ --------_ Size---- ---"":-------____--Liquid depth-_-__-_ -_-`_ Ca aci Disposal Field: Distance from nearest well----I --___Distance from foundation___/__......Distance to nearest lot line---- - x 1 Number of lines------------ILength of each line---------`2S--------------Width of'trench--------�Sf °"____-____-_ Type of filter _D er material__ -__��_ _ epth of filter materlal_____-f�_ _.___Total length _�____________________ v j t r ` Seepage Pit: Distance to nearest well-----/�a__ ._Distance-from foundation__.____7f-------Distance to nearest lot line--- yv_'__ Number of pits----------- --------Lining material---(?-1'- *A-Size: "-----De th----X-_�--I------- - -----� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____________-_____-_____-___-- ❑ d Size: Diameter--------------------------------------Depth- --------------------------------------------------Liquid Capacity----------------------------g-- , Privy: Distance from nearest.well__________.____-___ ,�-'____-______Distance from nearesf"15uildin -� v-------g------------------ -------_---------•--- [� Distance to nearest lot line - ---------------f------------------------ --------------------------------- -_ Remodeling pnd/or repairing {describe):--_ 6 ^.- � — ----- ------...04 -- W401 - ~� -----------------•---- --"---------.-_------------- ------------------------------------------------•: r ---'---'----------------------•--------------------------------------- ---------.------------------------------------------------------'--•--- ---------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Couni ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. LT ce _ (Signed) ` - ---------- . """ '' Rw or Contractor) By:--- �--ft -� ----- "�. '---- (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 ��APPLICATION ACCEPTED BY___---_____-� DATE"-- -�---------------------- REVIEWED ------------- - -- REVIEWEDBY------------------------------- ----------------------------------------------------------------------- DATE_ --- -----------•------------------------------- BUILDING PERMIT ISSUED---------------- --• DATE -��--------------------------------------- Alterations and/or recommendations--- ----------------- ------------------------------------------------- ---f----------- -------------------------- ---------•-------------------------------------------------------------------- -----------------------------------------------------------------•---------------------------------------------------- ---------•----------------------------- --------------------------------------------------------- ------- ------------------'------------------- ---------------------------------------------------------------------------- I ---------------------•----------------------------------------:-------•------------------------------------- --- --------------------------------------------------------------------------------------------------------•---- FINAL INSPECTION 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 6 ES-9-2M 8-51 Revised W-2100