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APPLICATION FOR SANITATION PERMIT Permit No,.-.__3_J_____._ (Complete in Duplicate) L — y Date Issued•'6 �•-__ _�.-� � 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 eNNo. S49. JOS ADDRESS AND IaQCATION-----------.7- L. f d` ----------------------------------- ------------- � -------- Phone-_ --- -------------------- Address.. -- -- Owner's Name------ '-----i 7J"' _ .. /-- Address...-------- r---- -- - --- -- -' '---'-----•--------------------------------------- --------------------------------------------------------------.__.....------- Contractor's Name---------- :- .i-- ---- - -------------'---------------------------- -- ------ Phone-- Installation will serve. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,l____ Number of bedrooms _ _-. Number of baths __/-__ Lot size _______________________ Water Supply: Public system ❑ Community system ❑ PrivateK Depth to Water Table.'�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ Previous Application Made: Yes ❑ NOX New Construction: Yes)( No E]TYPE OF INSTALLATION AND SPECIFICATIONS: // `` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / � Septic Tank: Distance from nearest well-, /,0__e-_-Distance/from foundation__I!Q_____.__.Material_____�C,_,,.� ]� No. of compartments-----a�:-------.__.__Size_,4_. __Liquid Capacity......57QrJ_f Disposal Field: Distance from nearest well_�d...._Distance from foundation_;,LO__________Distance to nearest lot line____-.�_________ Number of lines---- _____.__._______�____ Length of each line_______.l ____.______.Width of trench--------- _____________________ Type of filter material, " f'iC__.__Depth of filter material----/_F��________Total -length___________fd ------------------- ---- __________________ Seepage Pit: Distance to nearest well_- ___.Distance am f ndation.... Q...._.....Distance to nearest lot line-__�. ___._- C Number of pits.__.______________Lining material ,.,=�__r _-Size: Diameter___�Q_ __..____Depth____...,��______.________ Cesspool: Distance from nearest well_________________Distance from foundation---------.--------- Lining material------------------------_------------- f ❑ Size: Diameter------------------------- Depth-----------:------------------- --------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------.____-__.___..._. ❑ Distance to nearest lot line------------------------------------------------- ----------------------------------- ------ f Remod I}njg a /o r- p�air�ng (desert ):,, >>_ - -- _ -_ ..._.......... `- -� `'` _ zr -------------------------------------------- -------- -------------- --... -------••-•------------------------------------------------------------------------------------------ -------------------------------------------------------- ------------- --------------- ---- - ------------------------------------------- -- ------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. (Signed)----------- -------------------------------------------- ----Owner anor Contractor By--------------------�� '� �/i --------------•-•--- •------------------------•-•------ •-----------•----{Title �y� ��-• --:-'� (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be p,aded on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = '-------------------------------- DATE ---------------------------- DATE. --- - ' REVIEWEDBY------------------------- ------------ -----------------------= -------------------------------------------- DATE_--------------�---------- ------ BUILDING PERMIT ISSUED---------------------------- --- -- - ------------------------- DATE-------------------------------------------------------------- Alterations and/or recommendations-------------------------•------------------------------------------------------------------------------•-------_----•-------------------------------------- _• ------------- ------------------------------------------------------•-----------------------------------•---------•-•------------------------------------------------------------------------------------....------- --------------------------------------------------••-------------------------------- -------------------------------------------------------------------------------------------------------------------------•-•------------ -------------------------------------- tn FINAL INSPECTION BY:-------------------------��-�_� ---------•--- Date. ----�-----Z-a----- - 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 W-2100