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APPLICATION FOR SANITATION PERMIT Permit No. ..... Il-_-. Z/ (Complete in Duplicate) ' I This Permit Expires 1 Year From Date Issued Date Issued ____ __lf1c�� I Application is hereby madto the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made i4compliance with County Ordinan a No. 5 9. Uj II OwnersName - -� ------------------------------------------------ 1 Phone .JOB ADDRESS ANQ OCATION �- ----i- '�.----------•-••---- Address-------------------------------------- = = "Contractor's Name ILII: ...& �----------••---`-•------•---•------------------------ ----- Phone ----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial E]4 -Trailer Court ❑ Motel ❑ Other n❑ Number of livin unllifs: _/__ Number of bedrooms __i_ Number, of baths --- /. Lot size ._ " �� i'rf 14 Water Supply: Public system ❑ Community system ❑ Private [,Depth to Water Table. ft. Character of soil to a depth of 3 feet: Sand E]Gravel E]Sandy Loam ❑ , Clay Loam E]Clay E]Adobe 93---H-ardpan ❑ Ill; Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No FT�FHANA: Yes ❑ No ` TYPE OF INSTALLATION�:AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.] Swfic Tani: Distancre from nearest well ----------------- Distance from foundation -------------------- Material --..--__.--____"______.-_________._________.____. 44 SKU l n„ ` No. of` compartments---- ------------------- S � Liquid depth-- Capacity... Dispgsal Field: Distance from nearest well .._(. --Distance from foundati n.... _ __ Distance to nearest lot line -s, Numbehr of lines ------- __ Length of each line �&--- Width of french__'._ �______________ . Type filter material/jt_�� _Depth of filter material____ ________Total length _______%�jO------------------- Seepage Pit: Distance to nearest well_____________________Distance from foundat on____._...._.....___.Distance to nearest lot line .................. ❑ Number of pits ---------------------- Lining material ----------------------- Size- Diameter ----------------------- Depth --------------------------------- t^ Cesspool: Distant e from nearest well_________________ Distance from foundation ------------------- Lining material__._.___-_-.___.____._____________.__ Size: aiameter--------------------------------------DeP th---------------------------------------------------Liquid Ca aci} als Priv Distance from nearest well _________________________________________________Distance from nearest building --------- g F1Distanlceto nearest lot line ---------------------------------- --------------------------------- ---------------------•-------- --------------------------------- Remodeling and/or repairing (clescriea- `✓ -----------------------------------------------=-------------------------- -------------------------------------------- -------------------•------------------------------------------------------------ -----•----------- ...---------------------------------------- --------------------------------- --------� ---- ---------------- -- --------=-----------------------------------------------------------------------------------------------------'------------------------------- --------------------------------- - - - - - - I hereby certify thatil have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rul and regulations of the San Joaquin Local Health District. ____._____ Contractor (Signed) ) By:-------------- �Il�•----------------------- (TlfIs) ------ 1 (Plat plan, showing size of1lot, location of st m in rela#ion to wells, buildings, etc." can be placed on reverse side. u� FOR DEPARTMENT USE ONLY dh APPL{CATION ACCEPTED BY DATE ----- D= ------------------------ REVIEWED BY-------------------------------- - -------- - -=--- - •--------------- ATE BUILDINGPERMIT ISSUED_ --------------------------------------------------------------------------------- ----------------- DATE----------------------------`-------------------------- Alterations and/or recom9endations:----------------------------------------------------------------------------•---•-------------------------------------------•-----------------------------• _ ------------------------------------- I---------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------. -----•--------- �� ------------------------------------ ------------- ----------------------- ------- --------------------------------------------------------------------------------------------------- ------------------------------- FINAL INSPECTION BY--------------------------------------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300. West Oak Street ¢ +132 -Sycamore Street 814 North "C" Street 4 Stockton, California CJs ► -Lodi, California's . Manteca, California Tracy, California f E5�92M Revised S -'S9 F.P.Co.