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. APPLICATION FOR SANITATION PERMIT Permit No. _�_-7_ ��_. i (Complete in Duplicate) n Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 54%` JOB ADDRESS AND L TION-------- --- - -------- -- - ---- ------ -- ---- --------- Owner's Name------------ --- ----------------- -- - ---- ------------------------------------- ------------ Phones-_y0�- . Address-------------_------------- ` Contractor's Name Ott �-- -�---- ....... Phone--r9----�rlP Installation will serve: Residence Apartment House ❑p Commercial E] Trailer Court I-] Motel E] Other Number of living units:6?U-Number of bedrooms _Y__ Number of baths _Lot size --- ----------------------------- Wafer -r- _________ Wafer Supply: Public system ❑ Community system '❑ Private X Depth to Water Table//_t9_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No , TYPE OF INSTALLATION AND SPECIFECATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) \� Septic Tank: Distance from nearest well-_______________Distance from foundation--------------------Material_________-_---__.__._________-_________________. ; ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- If Dispos I Field: Distance from nearest wells.-�WL__-_Distance from foundation--A9----------Distance to nearest lot line_______ Number of lines---- _gipp_-_____ __Length of each line-_------ «.__.Width of trench_ ,_4'-------------------- Type '________ _________ Type of filter materiae___-�la�-Depth of filter material______- --------Total length----- ' _______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____________-___ ❑ Number of pits----------------------Lining material-------------_---------Size: Diameter------------------------Depth.-------------------_ Cesspool: Distance from nearest well---------_-------Distance from foundation--------------------Lining material-__________-____---------____________- El ------------------Depth----------------_- -----Li Liquid Capacity gals. ize: Diameter-------- --- - ---------------------------- q p Y- ------------------------g � Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____-_------______________-__--__-_-----. ❑ Distance to nearest lot line Remodeling and/or repairing (describe):___.__ f_. �► _ -------------- --- ----------- ---------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby. er+ify that I have prepar d this application and that the work will be done in accordance with San Joaquin County ordinances, S a laws, and rules an r gulations of the San Jo uin o f Health District. (Signed) R - - ----- ----------- � --- ter ( caner an�/ Contrac+or) BY --- ----- -- • - - ------ = ----- Title ----C-- (Title) (Plot plan, showing size of lot, location of system in relati +o wells, buildings, etc., can be placed reverse sideJ. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- f ,� DATE1 REVIEWED BY----------------------------------- / .. DATE /--------------- ------------------ BUILDING PERMIT ISSUED------------- ---------------------------------------------------------------------------------------- DATE Alterations and/or recommendations------------------------------------------- --------------------------------------------------------------------- -------------------------- •------------------------------------------- --------------------------------- -------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- --------------------------------------------------------------------- ---------------------------------------------------------------•------------------------------- ---------------------------------•- ------------------------------------------------------------------------------------------------------------------------ -----------------------------------------------•------------ ---------------------------------------- ------- ---------- --------------------------------------------•-------------------------------------------- FINAL INSPECTION BY:------ -✓- -------------------------- Date-.-- ./ = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M B-51 Revised W-2100