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Permit No. ____? APPLICATION FOR SANITATION PERMIT 9 I (Complete in Duplicate) /�7h%.Date Issued ____ �. 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 No. 549. JOB ADDRESS AND LOCATION---p�_0-r-_0......... /1 ------ _ .------------------------------------------------------------------------- `` ,A `` V_ - - ----------------- --- Phone _ .O8'.��..'(J-- Owner's Name------------- --• 'r��----------------------------------•------------------•----------------------------- !/1!C . _ Phone. -----•---- -- Contractor's Name------•---•--••--•--••- ---�.��,��------�_�-`r'--- ------------------------------- ----------------- ----------- �� –�-�---0T Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __./--- Number of bedrooms --2-- Number of baths .1--_ Lot size _S�VX_1. d__________________________________ Water Supply: Public system"tK Community system ❑` Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K Hardpan ❑ Previous Application Made: Yes ❑ No W New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank. NG Distance from nearest well_________________Distance from foundation--------------7......Material____._______._____.-___..__________-_.-___._--... ❑,60th No. of compartments--------------------------Size--------------------------------Liquid depth ------------------------Capacity---------- ------------ Disposal Field: Distance from nearest well.................Distance from foundation-------------------Distance to nearest lot line___________._.__. ❑Z�XcSfNG Number of lines------------ ---- ------------Length of each line-----------------------.------Width of trench- --------------------------------- Type of filter material---------------------- of filter material______________________Total length------------------------------------------- 7-0 _.____________-.______________._______- 0 Seepage Pit: Distance to nearest well_.�� —=_Distance from foundation___IQ-`__----Distance to nearest lot line--------___.__.._ "� Number of pits--../---------- _ Lining material.—_R9WG_---Size: Diameter-�.�_____________Deptn--��.-'______._--_-_____-_-- Cesspoal: Distance from nearest well__ --------------Distance from foundation--------------------Lining material__-_..__-_-______._.__.________._____. ❑ Size: Diameter--------------------------- --------Depth--------------------------------------------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------_*------------------Distance from nearest building---------------.._--_-__________.____,_._. ❑ � Distance to nearest lot line----- ---------------------- - ----------- ---------------•-------=-----------------=---°-------•------- ------ ---------------------- Remodeling -- --------Remodeling and/or repairing (desci=ibe):_._____._ ____ .t._ f________________ ---- _______I----------------_------ -- -----------------------•-••------------•-----------------------•--- ------ - ---- - - -- ------------------------------------------------•----------------------------------------•----------------------------------•-••------------------------------------------------------------------------------ I hereby certify that l have prep application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a egulati ns of the Joaquin Local Health District. (Signed)____ �'� __.�_ -------- (Owner and/or Contractor) ---- ---- - ----/` By:-------•---•-------- Gyp-a ---------- ------(Title)----- '---------------------------------- (Plot plan, showing size of lot, location of system in relation to well , buildings, etc., can be placI64 on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - ---- -- ------------------ --------• --•---------- DATE-- �---•-------- •-------------------------------- REVIEWEDBY------------------------------------------- ---- 7--- ----------------- --------- ---------------------- - ------------- DATE--.-- ------ -_ •----. ------------ BUILDING PERMIT ISSUED-------------------------- ------ DATE----.-.-- ----------- -----•-------- Alterations and/or recommendations------------ --- ------ ------------------- --------------------------------------------------------------- -------------------------- ---------------- ----------- ------------------- �/ ---- - �,� .... ..................................... ------ ----- - - - --------- --- -•- ---------------�----- -------- ---------------- ---- ----- - ---- -------------- 4 FINAL INSPECTION BY:_._. Date_..,. r S -•--�C----------- --------------•----- �-�•-- 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 E5-9-2M 145446 ATWCDD 12-sA }