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APPLICATION FOR SANITATION PERMIT Permit No.a� . .... . (Complete in Duplicate) <f Date Issued [�/ (22: PIP icatiSn 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 com lienee with County Ordinance No. 549. s z �_. . , _ JOB ADDRESS AND LOCATION__:________ _------ ---- , `'7- ------------------------------ Owner's Name------- ---- - - - ---------------- -------------------------------- Pone Address------------- -- ------.... - --- - - - - - Contractor's Name G- --------------------------------------------------------------------------------------- -- -- Phone------------------------------------ Instaliation will serve: Residence *4Artment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: r of bedrooms -7--_ Number of bathsl---- Lot size - m_ -__ + _____________________________ Water Supply: Public system ❑ Community system ❑ Private [a Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe � Hardpan'', l Previous Application Made: Yes ❑ No New Construction: Yes ❑ No I' TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is available.within 200 feet.) I q-P�� Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material-______-______-______-_________________---_--.-_ s ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-------------------- i Disposal Field: Distance from nearest weli__ ¢_______Distance from foundation__j _________Distance to nearest loft li�ee '�__'_____! , J Number of lines-----------,��--� _`--�- - Length of each line--------± - --i•------.Width of trench---- *'- -------------------id Type of filter material__�ii�__________Depth of filter material___ _____________Total length----.__ +�__�---_______-___.___-.___-- 17 � --- - do --4- --------.Distapce to Dear st��iine.147 Seepage Pit: Distance to nearest well_�✓'.�_ __-----------Distance_fro �foulnda_ti,,o�" f ] Number of pits-- __Linin materia�lR*--� _ ____ p- � = 9 p Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- I -....:.� Size: Diameter------------------------------------ Depth--------:---------- --------------.Liquid Capacity -gals. _l Privy: Distance from nearest" yell ._ _______________ Distance from nearest building------------------------------------------ E-1 _________ ___________________- ❑ Distance to nearest lat line_____ --- -- - __-- Remodeling and/or repairing (describe):---- ----- -- -- ---------------------------------- -- Y ----------------------------------------------------------------------------------------•------------------------------------------------•--•------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law , and rules and regulations of the San Joaquin Local Health District. (Signed) - ---------------------------------------------------------------------------------(Owner and/or Contractor) ` (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-- ---------------- ATE- BUILDING PERMIT ISSUED----------- --------- -____-- DATE---- --------`- ---------------------- -------------- ---------- Alterations and/or recommen ation :____ �� -"` '"__.__ / -- , .- - - - -------- --------------------------------------------------------------------------------------------------------•------------------ - ------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 -----------------------------------------------=-----------• --------------------- ------------------------------------------------------------------------------------------------------------------------------ FINALINSPECTION BY-------------------------------------------- ----------------- Date---------------------- ------------------ --------------------------------- i ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100