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r __ 'APPLICATION FOR SANITATION PERMIT Permit No: .f___::� " byi i Com lets in Duplicate) / � P Date issued .__----- .�/---s�• Alication 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."S49. JOS ADDRESS A LOCATION----� ------•----------- -------••---------- -------- ----------•------- --------- -- ------------ Owner's Name _ --- --------------------------------- Phone �� ---- ----- - - ----- --------- Address ------e - 014 ? ) --------------•-•---------------------...--------------------------------------------------------------------- �-� a .-. Contractor's Name---------------- � s --- Phone---- ---------- ---- k Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/---- Number of bedrooms - Number of baths --I__ Lot size _--- ,? -�------------ ---� ------------------- f Water Supply: Public system ❑ Community system ❑ Private ' Depth to Water Table Yj�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,® Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes ❑ Nox a TYPE OF INSTALLATION AND SPECIFICATIONS.- (No PECIFICATIONS:(No septic tank or cesspool permitted if public sewer is available within 200 feet.) e enk: Distance from nearest well-------- ------Distance from foundation------------ --.Material--------------------------.-___.----------------. P � No. of compartments------------ -------------Size------------------------•-------Liquid depth----------------- --------Capacity----------------------- tJ Disposal Field: Distance from nearest well, S�._.Distance from foundation-_---3-----------Distance to nearest lot lin ----------- Number --------- 1 r � Number of lines--------------- -- ------ Length of each line_------�>r---.-----_--.Width of trench.----�-5V-------------------- I Type of filter maferial--- r-- ----.Depth of filter material------Z.e-..........Total length-------- --- -------------_--------. Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line------..--..----- ❑ Number of pits------------------- Lining material-----------------------Size: Diameter-----------------------.Depth-------------------------- ------ Y ' Cesspool: Distance from nearest well-----_-.-_--__-_Distance from foundation--------------------Lining material--.----------_----------------------_ ❑ .Size: Diameter------------------------------------Depth----------------------------------------------: .--Liquid Capacity----------------------- gals. fPrivy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------.-------- ❑ Distance to nearest lot line------------------------------ ----------------------------------- ---------------------------------------------------1-- ------------- G Remodeling and/or repairing (describe):-----_ ---- i----------- ---------------- - ----- ---- -- - - - ---- ----- ---------- ---------- ------------ - 1 ----------------------------------------------------------F------ •-------------------------- -------------- ------ ------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r: t ) = _ ----------------- ---------- Y: = --( ner and/or Contractor) {Signed) J �f BY:--- �'"'" --------------------- -----------------(Title)-- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---- ---- ------ --- - --w--------'� 7 = .._---------------- DATE �].'�- rREVIEWED BY--------------------------------------=------ ------------ - --------------------------------- DAIE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:----- L___ -=-------------------------------------------------------------------------------------------------------•------•----------------------------.-.. ---•-------------•---------------------•------------•------------•--------------------------------•---------- -----•----------- ----------------------------------•----------------------------------------------------------- ' ----------------- -------------------------------------•- --------- •-------------------------------------------------------------------------------------•------------------------------------ --•------------------------- ----------------------------------- -------------------•-------------------------------------------- I------------------------------------------------•------------------------•--• --------------- ----------••-----•-------- ---------------------------------------- . FINAL INSPECTION 'BY;.........`'`I_- —- ------------------- ----•----- 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 t ES-9-2M 10-52 Revised W-2100