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APPLICATION FOR SANITATION PERMIT Permit No. __��__f�....�-•D (Complete in Duplicate) _ Date Issued -__..___l: r Appliceion 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 Ordinanc o. 549. JOB ADDRESS AND OCATION- _-- , ------- Owner's Name = - - - S•----- -- - -• --t--- Address.--------� --------------------------------- - ------------------------------------------- hone --- ---- -•- - ------ --- -------- -----_--------• -----------•-------•---------Contractor's Name....... , . - -- Installation will serve: Residence< Motel ❑ Other Apartment House E] Commercial ❑ Trailer Court ❑ ❑ Number of living units: _/_____ Number of bedrooms _,.I--- Number of baths J__. Lot size _�_____---- Water Supply: Public systerrp� Community system ❑ Private [] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:; Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes Hardpan (] - Previous Application Made: Yes ❑ No" New Construction: Yes gNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic an(C: Distance from nearest well_________________Distance from foundation---------,---------.Material__._.____-________. No. of compartments---------- ---------------size------------- Liquid depth ----- Capacity---------------------- = Disposa Field: Distance from nearest weil__< _..---Distance from foundation---1Q_.____-__.Distance to nearest lot line._______ --.. Number wo{ lines_____ Len h i C� � ;---.------ - g of each line-----��---y------- Width of trench.__- ��---- ----. --- Type or filter material�?��'1_r.. f {alter maternal-...�,� � ---------Total length----4- 4P----------------• -------- Seepage Pit: Distance to nearest well------_---------------Distance from foundation------------------..Distance to nearest lot line_.___--____.___. + ❑ Number'of pits-----.- ----_-'Lining material---------------- - -- Size: Diameter -----•--Depth-------------------- ----- Cesspool: Distance from nearest well_____ ____Distance from foundation.__-_--__________- Lining material_...__-__..______-----_---__ 5izo: Diameter Depth ------------- ----•- ---------------- -----Liquid Capacity------ p - --------gals. Privy: Distance from nearest well------------------------------_ Distance from nearest building ❑ Distance to nearest lot line°--____—-------`----------- �, . ofI ---- ----k------------ Rem deling a d/ r. a airing {describe :___�� _ �� ` ----•----------•- --------- ---••------••-- is LY ____________________._ ----------------------------------------------- --------------- --------- . -------------------- -- •------------- --- •---- ------------•-------------------•--------• ---- ------------------ - - --••------------------------•--------- --------------- -------------------------------------------------- I hereby certify that ! have prepared,ibis 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)- ' t ' kC '-------- -- ------(Owner and/or Contractor) - By----------------------------------------------------- ---- - - - ---- --- ------ ----------•------------ --------:---•-- --------(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 Alterations and/or recommendations---------------------- -- --' ------ ------ FINAL INSPECTION BY-------- ----------- --- ------ Date- --- SAN -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street 132 Sycamore Street , 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M 145446 ATW=D 1i- 4