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APPLICATION FOR SANITATION PERMIT Permit N .�`' (Complete in Duplicate) Date Applica4-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 Count Ordinanc o. 54 . JOB ADDRESS AND LQCAfT1ON_____ Owner's Name______ _ ____________-e- Address................ Contractor's Name______ 51 _______ ____________ j• -----------• .--------•------ -------••--------•----------------------------•---• �j --------C ''.:--------------- ---- Phonef/ V ----------------------------------------------------------------------------------------------------- Phone ----------------------------------- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ MMfiel ❑ OtherpP q Number of living units: ___L__ Number of bedrooms __. Number baths J. Lot size Water Supply: Public system ❑ Community system ❑ Private Vepth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam Clay Loam Clay Adobe �ardpan E)[ re Previous Application Made: Yes E]No V ❑ New Construction: Yes [?No [:][:] ❑ W TYPE OF INSTALLATION AND SPECIFICATIONS: `( (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic lank: Distance from nearest well_________________ Distance from foundation -------------------- Material ------------.-_-----_____ __-_______________.___. No. of compartments----------------- Size-------------------------- ___--Liquid depth_ Capacity____________-�_____ , Dispos +Fieri Distance from nearest well ��ez O_____.__Distance from foundation -Lv____�_____.?�isf*nceato nearest lot line _ IT ___ Number of lines ------------ _v --__ Length of each line --------- L_;0 Width of trench_ ---------_ ----------------- Type --_--_-- __ Type of filter materi - _ p -De Depth of filter material------�_-�- Total length ------ �-�Q------------------------ Seepage - -- --- 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 -------------------------------------- El _________.______:________________-❑ Size: Diameter-------------------------- ------ ---- Depth ---------------------------------------------------- Liquid Capacity ---- -------------------_-gals. Privy: Distance from nearest well ---------- _-------------------------------------- Distance from nearest building ------------------------------------------ ElDistance to nearest lot Zine ----------------------------- --------------- ---------------------- ____ ------------------------- ---------------------------------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------- -•---------------------------------------- .-------------------------------- ........ --------•------------------------------------------------------------------------------- -----------•.------•----------------------------------------------------------------------------------- -- 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 an rules and reuI tions of the San Joaquin Local Health District. (Signed) --------------------------------------------------- (Owner and/or Contractor) By: -------------------- ---------------------------------------------------------------------------------------------------------------- (Titlei---------------------------------------- ----- ---------------- (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 REVIEWEDBY------------ --------- ----=--- ----- - ----------------- ---------------------------------------------------- DATE, BUILDINGPERMIT ISSUED--------------------------------------•-------------------------------------------------------- DATE ----- '.--------------------------------------------- Alterationsand/or recommendations------------------ ------- ----------------------------------------------------------------------•-----••---S--------......------...----------------..... ------------------------------------------------------------------------------------------------------------------------...------------- ------ ------------....---.. _.. _..--------------------•------------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------•-------•-- FINAL INSPECTION BY_________________________ ___ I)/"-- - - ------- - ------ Date- 130 South American Streef Stockton, California ES -9-2M Revised W-2100 SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California