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olO APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued A pp pplica-lion is hereby made to the San Joaquin 'Local Health District for a permit to construct and install the work herein clescirised. This application is made in compliance with County Ordinance o. 549. JOBADDRESS ALOCATION-------------- --- ----- ------ ------------------------------------------ ------------- -- ---------------- Owner's Nam _- -- ---- ------------------------------------------------ ---------------------- Phone------ --- ------ Address- --------------- ---- ---- Contractor's 'Na'me, --------- ------ - - -- --- ----------- ------------------------------------------------------------Phone__, __ 4-- Installation will serve: Residence Apartment oAe E] Commercial E] 'Trailer Court [:] Motel ❑ Other El Number of living units: Number of bedrooms .2.- Number of baths _-)---- Lot size --------------- ------ Water Supply: Public.system Community system Ej Private E] Depth to Water Tabl'6011-40 ft. Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam E] Clay Loam❑ Clay E] Aclob ' El 9,4V Hardpa n Previous Application Made: Yes E] No New Construction: Ye -No L] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank.or cesspool permitted if public sewer is available within;':260 feet.) Septic pfic Tankj Distance from nearest well-----------------Distance from fouhdation--------------_....Material------ ------------------------------------------- 4 No, of comparf4en'fs;------------------.--.--Size----__-----------------1 7 _-___Liquid depth____.____... - - __._._:Ca acity---------------------- C.-Posal '1 lel Disfance from nearest well,-r_tjP1`Distance from foundation-/ Q_-_-----.Distance to nearest lot line---------------- Number or lines------ ------------------A4----Length of each line-------- -------Width of trench-------- ----------------- Type of filter materiaLe7-p-Z-A__.___Depth of filter material___. -------Total length---- mV-4?_':_____________'_." Seepa e Pit: Distance to nearest well_,_or_%,-vr------D'sta'nce-f m fou Distance to nearest lot line__.__� 57------ t 29 �;Z e" V) __�F --- ----------------- Number of pits-----/--------------Lining material_ Size: Diameter----- el"r-----Dept k...... Cesspool: Distance from.,nearesf well-----------------Distance from foundation__----_.---_-"_____.Lining material------------------------------------- El Size: Diameter----------------------------- -------Depth------------------A----------------------------------Liquid Capacity--•-------.------------------gals. Privy: Distance from nearest well------------------------------------------ "-f'--Distance from nearesf building---------------------------------------'-.- F-1 7 Distance to nearest [of ---------------i----------------------------I------ ---------------------------------- -------- --- Remodeling and/or re firing (descr;be):--------- - ------ _ -0-------- ................. .y__-______ ..__a.-"_-.__.. ....... --------- ----- ---------------- --------------------------- ------------- ------------------------------------------------------------------- - - --- -------------- ----------- ---- -- --- - ------ --------- ------------------------------------------------------------------------------------- ---------- ____________________________I -------------------_--- ------------------------------------------------------- ----------------------------------------------------------------------------------- ------------- I hereby certify that I have-pr ared this application and that the Work will be done in accordance-with San Joaquin County ordinances, State , and rules d regulations of the San Joaquin Local Health District. I (Signed)------------------ -- --------- ---------------------------------! ------------------------------------ (Owner and/or ontracfor) ----- By:-------------------------- - ------ - --------------------------------------------------------------------------..(Title)--- an onlracfo (Plot plan, showing sizec of, location f system in relation to wells, buildings, etc., can be pon reverse side).- • FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------------- -I ----------------------------------------------------------- ----------------------- -------- DATE--------- - REVIEWED BY --------- 6---- -_ -_ --------------- ----------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------- - Alterations ATE----------------------- Alterations and/or rec6mmendations:--------- ----------------------------------------------------------------------------------------------------------------------------------------------------- ffe 'ji ---------------------- --------------------------------------------------------------- ---------- -,-;F------ ------- le 7 --------- : -------------------------------------- ----------------------------------------------------- ---------------------------------------- -------- ------------------ ------- --------------------------------------------- --------- ------------------------------------ ----------------------------------- ---------------------------------------- -------- --------- A• ------------------------------ ------------------------------------/11) --------------------------------------------------------------------------------------------- ------ ----------------------- 7----- 45— aFINAL INSPECTION,-By:,-----h Date....... / i i -- ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 4 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100