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y ,h APPLICATION FOR SANITATION PERMIT Permit No (Complete in Duplicate) Date App lica+ion is hereby made to the{San Joaquin Local Health 'District for it to construct and install the work herein described. This application is-made in compliance with County Ordinance No. 549. JOB ADDRESS AND ATION >+-•• ��,�s ------------------• ------------------- ----------------- Owner's Nam --- -------------------------- --------------- Phone----- ----------•------------- Address___ _ t Contractor's Name-----_1--------- ----- •- ; '� - � one--•------_------------------- - ;5�' Installation will serve: Residence Apartment ouse E] Commercial ❑ Trailer Court E] Motel E] Other El Number of living units: -- Number of%edroomsa __ Number of baths /____ Lot size -1 0_-_______________________ Water Supply: Public system Community system ❑ Private L] Depth to Water Table�4t. Character of toil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [- Previous ardpan ❑Previous Application Made: Yes ❑ No New Construction: Ye� No E] TYPE OF INSTALLATION AND SPEC]F✓1C.A�TIONS: (No septic tank or cesspool permittedif public sewer is available within 200 feet.) p Septic nk: Distance from nearest well-----------------Distance from foundation____.___-_--______.Material________-____________---____________________-___. ' No. of compartments---------- ---------------Size------•----•-----------------Liquid depth--------------------------Capacity----------------------- Ud Disposal Fi d: Distance from neare t weli.,.x�rDistance from foundation_/_________.Distance to nearest lot line-_--_ .--. "� Number of lines_____ _________________ ____Length of each line__________ __G r Width of trench.----- ___.__.__._ . Type of filter material _ ejf__--._Depth of filter material-.-/Y __._Total length-------- !_...-------------------- Seepage Pit: Distance to nearest well-.-.__________---- --Distance from foundation_____'"--------------Distance to nearest,lot,-fine-------------- _ - ❑ .,. Number of pitsSize: Diameter______________ _____--- -------------------Lining material---------------------- Depth-----_-------------------------- � Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining materials ---------------- {� Size: Diameter❑ ----------------------------De th-----------------f----------------j —Liquid Capacity------------------ gals, Privy: Distance from nearest well _____------------------------------------------Distance from nearest building------------------------_____.____-___.-. ❑ Distance to nearest.lot line--------- -------=----------------------------- Remodeli and/or repairing (d rias) �_ i _.. -=------------•--------------- ------------ ---------- - --------- ---- -- -----•-- fJ_ _ __ -_• _-_____ _ • ______________________________•-___....._ -_ -- # _Y-•---------------------.....----------------------------~�____ t I hereby certify t I have prepared this application and that the work will,)ie done in accordance with San Joaquin County ordinances, State laws,'a les a e gletions oft#las Skin Joaquin Local Health District. (Signed)-.. .--- _ ----------------------------------------------------- (Owner and/or-Contractorl SY� , ''-� ------------------- - - -----Title ---- --- ,. ( ) (Plot plan, showing size of lot, locati n p g f`sys em in la ion to wells, buildings, a+c., can be Vac . on reverse sid� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE. --- --------- •--•----- ------------ REVIEWED BY----------------------------- DATE BUILDING PERMIT ISSUED------------ -----=---•--------------------------------------------•-•----------------------=------- DATE-------3&�' Alterations and/or recommendation's------------------- -------------------------- -------------------------------------•- �-► --------------------------------------•------- ----------------------- ------------------------------------- ----•--------------------- -------•--------------------------------------------------------------- -------------------------q------------------------------------------- ---------•-----•---•------------------------------•--------------------------------------------------- --------------- -------- ----- ------------------------------------------- -•----- --------------------------- --------- - --------------=-"--------- _ ----------------------------- FINAL INSPECTION 'B :- €}ate -------- ------ --------- --- ------------- ------------------ 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-4-2M ; Revised W-2100