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APPLICATION FOR SANITATION PERMIT Permit No. __ - (Complete in Duplicate) ti Date issued 25:,T;2__ 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. I .- JOB ADDRESS AND LOC10 _ •��. ------------------------------ . I -- -------------------------- Owner's Name----------------•- -----�- ------------ - - - ------------------- ------------------ Phone----- =' ------- - -- - ' ----- ---- Address-------------------- - -- --------- ----------------------------------------------------------------- ----------------•------------•------------------------- Contractor's Name----------------- - - -----�•------------------- ----------- -------------------- ---------- --------------------------------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial I ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: --------- Number of bedrooms ________ Number of baths -------- Lot size Water Supply: Public system N Community system ❑ Private.❑ Depth to Water Table _:------ f+,,- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ z Previous Application Made: Yes ❑ No X New'Construction: Yes ` No ❑ TYPE OF`INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) RSeptic Tank: Distance from nearest well___Ji7______Distance from fou dation_____-_C__0_ __ r Materiel__ 6No. of compartments_____�___�________Size______ - 4-�---------------Liquid depth------------- --------Capacity----0_ 0--------- ' Disposal Field: Distance from nearest well___ _Distance from found do 0 !`'j'j� Distance to nearest lot line--___ _----- Number of livres_____________ __ Length of each 641- Width of trench______: _ { Type of filter material - Depth of filter material__-______ _ r� -- ------------- -- ---- - ----- ------Total length------ r . 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------------------------- ❑ Size: Diameter-----I--------------------------------Depth----------------------- - ----------------Li-'--Liquid Ca aciI fY----------------------------gals, Privy: Distance from nearest well---------------------------------- Distance from nearest building 9 ❑ Distance to nearest lot line______________________ I ----------------- Remodeling and/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 laws, and ales nd regulations of the San Joaquin Local Health District. (Signed)------ _____________ ---(Owner end/or Contractor) BY: Tale (Plot plan, showing size of lot, locationjof system in relation to-wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY -------------- APPLICATION ACCEPTED BY___________ _ _ _ - DATE__ = ------. REVIEWED BY__•-------------- -- ----- --------- DATE -- -- -------------------------------------------------------- BUILDING PERMIT ISSUED_________________________ --------------------------------------- ---------- ----------- ------ ----- ---------------- DATE---- ------------ ------- - -------- Alterations and/or recommendations:_________-_______._ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ _ - ----------•---•--------•- FINAL INSPECTION BY:_______-- __- _ -- ----------------- Date----------------- --- -�.' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street t Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Revised W.2100