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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 herei described. This application is made in compliance with County c33 ci Ordinanc No. 549. JOB ADDRESS AND LOCATION--------------------7-----7-- . -------------------------------------------------- Owner's Name - -------------------------- --------- -------------------------------------- Phone------------------ .---A01 t 1. Address `'E''''~`— "= t ----------------------•----_------------------------------------------- -------------------------------------------------- = = ".rc `' ,k. Contractor's Name------- -- -- -- Phone.----•-_---- 'F` ---------- - =. . Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other-cl•i s` Number of living units: -------- Number of bedrooms ________ Number of baths -------- Lot size :! Water Supply: Public system El Community system El Private E] Depth to Water Table -------- ft. ' __�___ r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam A ,o -,/9"❑~ Hardpan ❑ ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (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----------------------- Disposal Field: Distance from nearest well.......... ---..Distance from foundation-------------.------Distance to nearest lot line-_____.___-_-.___ ❑ Number of lines-----------------------------------Length of each line----_-------------------------Width of trench Type of filter material------ -_-----_---------Depth of filter material---------- length______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----------------- El Number of pits------------------- Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- r� Cesspool• Distance from nearest well--------------___Distance from foundation--------------------Lining material-----------------.___-______________- ❑ Size: Diameter---------------------- ---------------Depth-----------------------•------------------- -------Liquid Capacity "" --�----------------------------gals. "V Privy: Distance from nearest well__..__. _ _ _______ --._._-_______ Distance from nearest building---- o--------- - a Distance to nearest lot line_... l_ `n Remodeling and/o,- repairing (describe): --- - ----------- --- -- ------ --- •-----•-----..--- ---------..'�r4-------------------- - - -•---•-- ------ ----------- ----- ----•------------ ------------------•--------------••------------ -- ------ = -------------- ----------- --------------------------------------•----•------------------•-•-•-----•--------------•-----•-------------------------••--------------------------------------- ---------------------- 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. (Signed} --- ---- ------------------------------------------------------- ------------------ (Owner and/or Contractor] By:------------------------------------------------- ---------------------------------- ----------------------------------------------(Title)------------------------------------------------- •------------ (Plot pian, 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------ ---------- Alterations and/or recommendations:.... _. n7-- -�d -- __---C[----___ __ ,, . - �► - .. -- t-- 7 -----------------------------------------------------•-•-----------------------•-111 - ------------------------------------ 1 ------------------------------------------------ ----------------------- --------------------------------- ----------------------------------------------------------------------------- -------------------------- ----------------------------------------------------------------- - --------------- -•------------------------------- ------------------------------------------•- ------- ------------------------ FINAL INSPECTION BY:-- Dae. f-z 1 � ------------------------------------ � *---------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street l Stockton, California Lodi, California Manteca, California Tracy, California j k) E5-9-2M 745446 ATWOOO 12-54