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I APPLICATION FOR SANITATION PERMIT Permit No. ..-1.-�_ �! a (Complete in Duplicate) 7,; / J �j Date Issued / Application is hereby made to the San Joaquin Local Health District for a permit t construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �� JOB ADDRESS AND LOCATI .. : ,.."_ ; lir------------------ > Owner's Name----------------------- ------ Phone------- •------------ I Contractor's Name---- ---------------------- ------------------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial I-] Trailer Court E] Mo.!p� ❑ Other Number of living units: _ Number of bedrooms__._ Number of baths __ Lot size __-_, __ ________________________ Water Supply: Public system ❑ Community system ❑ Privateepth to afer Table Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Mader Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if pubic sewer is available within 200 feet) f Septic Tank: Distance from nearest well 0__"' _Distance from fou; ation_� �' Mat rial __�; - - -- ---__�_________________�. Y No. of com artments_._____. Siz ��''� - -Li de t �__2r_________Ca D P — P. IL P Y Disposal Field: Distancefrom nearest well from foundat // __ Distance to nearest lot�Sne__ © Number of lines----------21----_ _Length of each line-45-_ _s+_ _ .Wicifh of trench,. - _. f Type of filter material-_5„_` ___ epth of filter material___. _ ___ ._Total length--------- E 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-rearest well_-:_=__-----.—•Distance,fnom.foundation_____________________Lining material,-__-------------------------------- ❑ Size: Diameter------------------------------------ Depth-------------------------------- --- --------------Liquid Capacity... - y--- -gals. Privy: Distance from nearest well------ _____________________________________Distance from nearest building______.______.________________--.__..-.". ❑ Distance to nearest lot {ire--- - -- ------------------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe)-------------- ----------------------------------- ----------_--------------------------•------------------------------••-- - --------- ----------- ------------------------------------------------------------- ------------------------•--------------------------- I hereby certify that I have prepared this application and that +he 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 ` (Owner and/or Contractor) By:---------------------------------------------------------------------------------------- - ----------------------------------------(Title)----------•----------------------------------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). _ RT D EP4-AR�ME ' -USE-O _y_ APPLICATION ACCEPTED BY------ = Z_ - ----- ------ --- -- DATE---- ._- ' ---------------- REVIEWED BY--------------------------------------------------------- -------------- _ - DATE------ ----- -- --- --- ---------------------------------------�------- -- - ------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- -------------------•----------------------------------.--•------ --------------------------------------------------------------,-----------------------------------------------------------------------•-----•-------- -----------------------••--------- ------- --- --- 9// J FINAL INSPECTION BY: 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 `. ES-9-2M Revised 1,57 F.P,CO. i ,