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APPLICATION FOR SANITATION PERMIT Permit No.Date Issued ---_. _-1-T Application is hereby made to the San Joaquin Local Health District for a permit to cons (Complete in Duplicate ' 5�7-�,� �i�t and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.i Owner's Name__-._ _ -- e ( ----------------•---------•---------------------------------------------------- Address Phone 4 '�. .. -------, t = ...--. Contractor's Name---- Installation will serve: . Residence House Comm f ❑ mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -------- Number of baths --__ Lot size Water Supply: Public system ❑ Community system ❑ Private E1�J-e pth to Water Table -AQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 6--Hardpan ❑ Previous Application Made: Yes ❑ No E5:., 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: 456Distance from nearest well 1Z1$ r -✓'___-Distance from foundation--._- __ - No. of compartments e ------ --- --Material------------- F P Size--.--J� ------- I Liquid depth -..7,L ---- Capacity isposal Field: Distance from nearest well___ .-.-.Distance from foundation-___ __O_e � ` - Distance to nearest lot line--_ _Q__`_•. Number of lines-_ ----------I__�_. _-_-_--,_Length of each line-------05 .. .... Type of filter material__/_ Width of trench----- _- ' t--- -Depth of filter material--_---/8--!---.Total length---__- -- Seepage Pit: Distance to nearest well----------------------Distance from foundation-----___.__...-----.Distance to nearest lot line--.---_---..---_ ❑ Number of pits----------------------Lining material---- Size: Diameter ----- ---------DeptM----- ------- -------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- Lining material-----------------El .size: Diameter----- -------- ---- ----------Depth----------------------'--�-------- ---- -----I ��,.._ ----------Liquid Capacity # z, _ �. -,-I ---------9a Privy; Distance from nearest vrell ____________......_ _ Distance from nearest buildin '"'"•` ❑ Distance toynearest lot line--.-__.__ g--- -- -- -- --- � --------- -------- Remodeling and/or.,repairing fdescribe):--.---____________ ------ --------------------------- --------•--------------------------•----- I hereby certify that I have prepared this application and that the-work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and"regulations of the San Joaquin Local Health Disfrist i I (Signed)_. ---'�4""10-044"Contractor (Plot plan, shown size of lot, ------(Title)-------------------------------------------------------------- ) P g frication sof system in relation to wells, buildings, etc., can be placed on reverse side). -- ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- - ------------ ---------------------------------------- ----•--------•------------------------ --- DATE---- -------- •------ REVIEWED BY--------------------------------------- } BUILDING PERMIT ISSuIrD---------------•.--i _ -- ---- ---�----- DATE and/or recommendations:.._____---- --_-- Alterations ----. DATE i --------------------------- ----•----•----•---- ----- ------•---------------------------- ------------------------- -•------- ------------------- ---------•-- -------------------------------------------------- ------------------ FINAL INSPECTION BY:.-- ate. F d7 SAN JOAQUIN LOCAL HEALTH DISTRICT / r 130 Sou}h American S}ree} 300 West Oak 5}teat 132 Sycamore Street Stock+on, California 814 Nor}h "C" Sfreef Lodi, California Manteca, California Tracy, California r ES-9-2M 10-52 Revised W-2100