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Permit No. •- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued Application 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. _ - ------------- -------------------- JOB ADDRESS __ ____________________________________________________________________________ _ _ _R_ JOB ADDRESS A D LOCATION---.------ --- - ---- --------- .{{ -- - ------- p ----------------------- ---- _-- Phone----=.e------_-- Owner's Name_______________ ______ f, -------- ------------------------------ -------------------- ----------------------- -------------------------------------------------- Address----------------- Phone----------------------------------- Contractor's Name__ -____ „ -_ ------------ - --- --- ---- -- -------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo/tu} ❑ Other Installation Number of baths -______ Lot size ___ _. I U Number of living units: __�____ umber of bedrooms ____ - Water Supply: Public system [� Communit system ❑ Private ❑ Depth to Water Table -------- ft. Pp y� Y Y Character of soil to a depth of 3 feet: Sand Gravel F1 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E]Previous Application Made: Yes E] No ( New Construction: Yes VN° El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted 'f public sewer is available within 20D feet. 1, ------ ------ we 'i1. ✓. l' �f 4 1 I M,aeJ3al Septic ank: Distance from nearest ll____ is e6r��oun�°q -- p "r Capacity - M No. of compartments------ _ (/ ------ Li Did de h p Y S --/�(-----Size__------- --- 1 .l} .____Distance to nearesVo i _ Dispos Field: Distance from nearest w Distance from foundation __ ____ Number of lines__________ _ --__--_Length of each line________f___r� _ r�---.Width of trench_-___; ____-----��((� -------------------------------------- Type of filter materi __._� Depth of filter material_____-_____ _______TOtal length.-------- --- c�-------------- Seepage Pit: Distance to nearest well---_------------------Distance from foundation----------------.._.Distance to nearest lot Gne____________-____ _ Depth----- -------- ---------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---_------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining nuid Capacity material r __________._____________.__gals. ❑ Size- Diameter------------ ------------------------Depth--°--------------------------------------------------- q Privy: Distance from nearest well--------------- Distance from nearest building------------------•------•------------- ❑ ----------------------------------•---- Distance to nearest lot ine------------------------------------------------ Remodeling and/or repairing (describe)--------------------------------------------------- -------- ---------------------------------------------------------- - - - --- - •-- - ------ ------------------- • ------ - done I her ebstcate rla sh andhave rulespandaregulatsons.olf the San Joaquin n Local Heawill ltheDistr cin accordance with San Joaquin County ordinances, (Signed)--- � `M x ;";L--=-=1- -'-11�------------------- ----------------------------------------------------------- -------------------------- ---------------------------(Owner and/or Contractor (Title) By-------------------------------------------------------------------in n --- -at---i- buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location of system relon to wells, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -------------------------------------- DATE- ' - --------------------------- DATE- ------- REVIEWED BY ----- •---- ---------------------------------------------,------------------------------- BUILDING PERMIT ISSUED-------- ------------------------------------------------------------------- DATE_- ---------?------------------------- Alterations and/or recommendations:------------------------------------- -- - ------------------------------- - ----------------------- ----------------------- -------- le FINAL INSPECTION BY: •x '•"---------- Date - ------- -- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Tracy, California Stockton, California Lodi, California Manteca, California Y. ES--9-2M 8-51 Revised W-2100