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�( APPLICATION FOR SANITATION PERMIT Permit No. __. ___...._ _ - (Complete in Duplicate) - Date Issued ----- -_ Applica+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 No. 549- j JOB ADDRESS AND LO ATION-�„ 4`__ - Owner's Name------ --•-----•----- •------- "�` Ph----•----------------------- - ------------------ one Address 'Z_--------" -•-- --- - ---------------------------------- Contractor's Name-------------- ------..604._i,__ ----- -----•- -----------/L------- -- ---- hone------------•------ •---•--•------• Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E3Motel ❑ Other ElNumber of living units:._./-__ Number of bedrooms __ •;.Number of baths --- __ Lo{t size _ _.. ...................•_ Water Supply: Public system Community system ❑ Private E] Depth�to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam'E] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes I] No ❑ TYPEPOF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f p Distance from nearest well------___________Distance from foundation-__-_-__--___-____.Material__._.____.__.______...-_- No. of compartments--------------------- ---Size---- = -------------Liquid depth------------------- -----Ca Capacity Y ispos.. J el d: Distance from nearest well_-_'_.._____- -Distance from foundation._______ _____ Distance to nearest lot line----------------- Number of lines-----------------------------------Length.df each line_---------------- ------.Width of trench------------_--_-- Type of filter material.........................Depth of filter material--------------.-------Total length--_-__--_____-----_--_---__---__-_-_----.- Seepage Pit: Distance to nearest well--)I-t?"-'C----'---Distance from ound ion_____-____:•-___--_.Distance to nearest lot line---------------- [ � Number of pits__ ____________Lining- material_e.e/ ixe: Diamefer__ --------Depth f '- ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------.------------------- � ❑ Size: Diameter--- ,_-------------------_---------Dept h------- iameter- ----------------------_---------Depth------- -- - -------=-------- - -------------------Liquid Capacity- --------------------------gals. 01V Privy: Distance prom nearest well------------------------------_-_ ---------------Distance from nearest building ❑ Distance to nearest lot line________.-____._._ j ( I Remodeling and/or repairing (describe):__.-----_._ -- ._- - ----------------- ----------------------------------------------------•------- "-••-- l --------------------------------------------------------------i I--.. -------------- ---------•----------------•------•------------••------•-----:------------•--=--------------------------•-------------------------------------- ------•------------•---------------•------------------- 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. 1 I (Signed)----- ------ -- - --------- caner and/or Contractor] f BY• sc (Title) - �iF -------------- (Plot pian, showing size of I , location of system in relation to wells, buildings, etc., can be placed e}. FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY--------- rDATE_____- -------------- ----------------- REVIEWED BY------------- -------------------T ----- ----------------- DATE-- ------------------------------------ BUILDING PERMIT ISSUED------------ A------------- ----- ------------ ------ DATE --------- - -------------------------- Alterations and/or recommend ations:..................... --_---- •__._- .. _ _ f"'- ------ - •-•---------------------------•- --- - ------------------------ --------------------- ------------- -----y...----------------------------- --------•-•--- { FINAL INSPECTION BY:...._. . -_ - -- --- - ---------- 1 . I SAN JOAQUIN LOCAL HEALTH DISTRICT J 130 South American Street 300 West Oak Street 132 Sycamore Street b 814 Worth "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I! Es-9 145445 ATwppo i