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141 ` 7-7 APPLICATION FOR SANITATION PERMIT Permit No. .. (?_ _�•-•- (Complete in Duplicate) Date Issued ---�vyl*_ 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. JOB ADDRESS AND L CATIO y -------- _ ,. Owner's Name ------- _ - Phone -------- - - -- ----------------------------•----------- Address.............. Contracto Installation will serve: Residence [Apartment House ❑ Commercial ----- - ' --------------- Phone_ -�-Q( ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/____ Number of bedrooms —1. Number of baths ___A_. Lot size _______ __________- -- -• ft. 1 Wafer Supply: Public system 0- Community system E] 'Private El Depth to Wafer TableC Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p AdobeQ Hardpan ❑ k Previous Application Made: Yes [❑ No (}- New Construction: Yes 5�__No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: _ �Disfance from nearest well-----------------Distance from foundation-------------------_Material ____-_._____-_._ of compartments❑ Size-----------------------•--------Liquid depth--------- Capacity----------------------- Disposal Field- is4ance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line___..___________ Elber oflines--------------------- ---- --------Length of each line---------- ------------------Width of trench -- YPe of filter material-------------------------Depth of filter material-----------------------Total length....................... -- --- ----------------- - Seepage Pit: Distance to nearest weli_ . Distance from foundation____ D- -__-.Distance to nearest lot line---_* ----- Number ofits...---_ P �--------- Lining matenal•- - -- -----s;�.�ize: Diameter- --- __.----Depth----jF;F��-------------- Cesspool: Distance from nearest well_________________Distance from foundation------------------..Lining material--------------_.___-___.__-- ------_- -K El Size: Diameter------------------ --- ---------------Depth----•----- ----------------------------------------Liquid Capacity-------------- -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line Remodeling and/or repairing (describe)__________________________________ -------------------------- -- -----•-------------------...-----•-----------•-----------------------•--•--------••--------------------••--------------------------------••-------------.--•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I nd rules and regulations of the San Joaquin Local Health District. (Signed) .. --- ------- -------------(Owner and/or Contractor) --------------------------------------(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 BY --- --- --- - DATE BUILDING PERMIT ISSUED------------------------ �_--- -------- DATE-------.__.._------ ri ---`f~------- - ------------------ Alterations and/or recommendations:------------------ ----------- _________ _ ----- •--------------- --------------- --------------------- --------------------------------------- - !. . ------ .. _ - - .._.._. --...-- �j------ ---- ---------------------- ---------------------_---------------------------------------- FINAL INSPECTION BY:..-- } bate .. -------------------------------------------------------------- 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 EE;__9_2M 145446 g7W00D 12-94 f