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SANITATION PERMIT Permit No. ..._rJ'_ q_J...__ APPLICATION FOR SA (Complete in Duplicate) Date Issued 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. -------•------------------------- ---------------- JOB ADDRESS AND ILO CAT ION ° F ------------------------------------ Owner's N- a.meJ f ' •---v------------------- --- Phone 9-- ---------------------------------------------------------------------------------------- Address------- -----!-- - -qz . ------------ Phone----------------------------------- ---Co --------- ntractor's Name---- 4 ------------------------------------ installation will serve: Rsident Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ rooms ..__ ._. Number of baths ._L_-_ Lot size ._.__f --- ------------------------------------------ Number of living units: _-.I-__ Number of bed Water Supply: Public system ❑ Community system ❑ Private k.Depth to Water Table --- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: Yes ❑ No pyk,., New Construction: Yes g No ❑ k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Septic 'Tank: j,.1 Distance from nearest well-----------------Distance from foundation--------------------Material-.--_-----__.___--_---.--__-----_---.----._..-. o. of compartments.-------•----------- ---Size-------------------------------Liquid id de th__-..-_--_---------------Cap`acit Y------------ -- ------ ---- -- --�---�------- --- ea'restwell-__�l.0�0j-yistance from foundation_.A_ _""Distance to neares.t_.lot-line .'Disposal istance from nb -p--------- Width offrench..- ,-Depth rench... CDepth of filter mNumber of linesµ..----I--------------- -Length of each line--- -_-1.0-QW--- filter"' -. filteraterlal., Tmaterlal. c , -------Total length Type of , P Seepage Pit: Distance to nearest wellmfoundation--------------------Distance to nearest lot line----------------- d ElNumber'of pits- ___......... -____--- Size: Diameter-- -- -Depth-------------------------------- ' ► t ❑ --;-------------------Lining material-------------- Cesspool: Distance from nearest well----------------- from foundation".................._.Lining ------------------ ----- material ._......_.-.-.___.:...._-.____"...�...-�_„_. ----_----Liquid Capacity�v----------------------gals. Size: Diameter---- ------------------- Depth- Privy: - . Distance from nearest well------------------------------------------------Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line----- -------- ----------------------------------•----------------------- --------------------- -- 'f -------------------- Remodeling and/or repairing (describe):..___._._-_ --- � t --------------------------- ------------------•- ------- ----------------------- -----------------------------------------------------•------------• --------------------------------------------•------- ------------- ------------•----------•-------------------------------------:------- 1 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 rules and regulations of the San Joaquin Local Health District. I r -------------------------------(Owner and/or Contractor) (Signed] �+'� �'�-.,�. --d�- ��- "- -- - -- ------ --------------------------- ------- - ----- ---- By--------------_-----------------------•----------- ---- - --- - - -- -- Tale - - - - - - - - -- - ------------------ ------------------ - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---------------------------------------------- DATE------------------------------------------------------------ - ---------------------------------------- ----------------- REVIEWED BY F: C DATE__.- —f__ Y' � --• BUILDING PERMIT ISSUED----------------- --kk -----•- ' DATE------------------------------------------ ----------------- Alterations and/or recommendations------------------------- ------•----------- ---------- ---------------------------------------.----------- -------------------------------------- - ------------ --------------------------------------------------------------------------------------------------- --------------------------- ------------- FINAL INSPECTION BY------------------- - - Date------------ -----------------_- SAN JOAQUIN LOCAL HEALTH DISTRICT 814 North "C' Street 130 South American Street 300 Wast Oak Street 132 Sycamore Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10.52 Revised W-2100