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APPLICATION FOR SANITATION PERMIT Permit No. . .......•..__.. ` cate (Complete in Duplicate) p ) Date Issued __I -------(,... 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- { L JOB ADDRESS AND LOCATION-- _--' _ :_ -------- 4 - a-- - -------------- ---- --- ----------------------------------------- Owner's Name- -- --------------- -- ----- Phone-------------------------------------- Address ------------------------- ---- w Address------------ ------------------------ ---- --- Contractor's Name-- ---------- -------- ------------------------------- ----------------- ----•--------------------------------------- MPhone-----------------------------= Installation will'serve: Residence ❑ Apartment House E] Commercial ❑ Trailer Court Y tpotel 0 �jOther Number of living units: ________ Number of bedrooms _-_.__-- Number,o baths ________ Lot size ___ _-..P1C�_ 1 -________-- ;----_ Water Supply:' Public system ❑ Community system ❑ Private. Depth to Water Table .-- ___ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam 0 Clay Loam Clay ❑ Adobe ❑ Hardpan ❑--\—. , Previous Application Made: Yes ❑ No +[ New Construction: Yes [f No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: # (No septic tank or cesspool permitted if ubiic sewestancer is efromewithin founda�04 feet)ip. _-_ ' at rias .��._� ��-.�__.... Septic enk: Distance from nearesr wei____._ # p r f No. of compartment _.__ . ____._Size_-_-- ._ciquidfh_ _- ' "..__.Capacity-e— Dispos Field:; Distance from nearest ,:ell_. ._ _ __ istance from foundat'o .__. _ ___ istance to nearest;lot kin ---------------- r -- . Number of lines _________ _____ __ ____________Length of each line_____ _ `__ MWidth of trench____aa± _r. fr a T---------- 1) Type of filter materia __ l Depth of filter material-------- - --------Total length-__------t -_---_--_-_- Seepage Pit: A � Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line------------------ El Number of pits.---------------------Lining material-----------------------Size: Diameter-----------------------Depth----------------- _-------.----- 3 Cesspool: Distance from nearest well-:......... .:_Distance from foundation--------------------Lining material------------------------.-__---______. ElSize: Diameter--:--- -------------------------------Depth------------------------------ ---- ----------------Liquid Capacity---------- ----------------- [ Privy: Distance from nearest well--------------------------------------------------Distance from nearest building---------.-_..--__------•-------_---. ❑ Distance to nearest lot line-- ---------------------------------------r---------------.---.-.-'-�-------=---------••------• emodel'hg and/ In r repairing � n ' ------------- -- -- - - ---- t- - --- ----- ------------------- ------ -- �------- -- J + ---------- --------------� ..--•-------- �--------------------�--------•----•------------------------------- ;. :....# v I 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 re ulations of the San Joaquin Local Health District. i , (Signed/- -------------------------- ---------------- ---------- - (Owner and/or Contractor) - ------------------------- Y �— -G- - --•--- ------(Title)-------------- ----------------------------------------------- (Plot plan, showin 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-- DATES- "•� REVIEWED BYowia ----------------------- •--- - DATE-- ------------------------- BUILDING PERMIT ISSUED-------- -------------------------------------------------------------------- -- ------ DATE------'r`"-... _ Alterations and/or recommendations: •-------------------------------- ---------- ---------- -----------------------••----•----------------------------------------_.-._.....-..-•----------------=-----------......-------=----- --- ------ -- ---------------- --- -------- ------ -z- FINAL INSPEC Y-- --- ----------! --------- Date--.... ----- 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 r �, y E5-9-2M 14s446 nrw000 12-51