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�? � ?'� /►� Permit No. APPLICATION FOR SANITATION PERMITIV (Complete in Duplicate) Date Issued . plica+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 o. 549. •. JOB ADDRESS AND CAT O ___----_ ___ _ _��__ ___ Owner's Name --:------•------------------------- - ------------------------------------------ Phone----2 '" --------- ' Address _- ------•----------- ••- ----.. Contractor's Name----------------- --- ------------------------------------------r-------------------- Phone-__3- � Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J___ Number of bedrooms __/.__1- Number of baths _-f____ Lot size - 1`d- -_l _ _________________________ Water Supply: Public system A Community system ❑ Private ❑ Depth to Water Table*'�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe Hardpan ❑ 1 Previous Application Made: Yes ❑ No. New Construction: Yes4`.No ❑ ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well- '--Distance from founcla`ion___A4�__..__.Mate rJ)'al...... .p� No. of compartments_._..__. ,-2 ........... Y Liquid clepth. _9 --------Capacity_...,F J� , Disposal Field: Distance from nearest well�rtr__._Distance from foundation__�l1-----------Distance to nearest lot line__________ f .-___._ Length of each line__ _a_-_____________Width of trench_ ___ Number of lines_______��_-__--_ g Type of filter material __ _ _______Depth of filter rn �t' al___ ---___-____Total , length-------- Seepage _______See a e Pit: Distance to nearest __-__Distance onk fodtion___pna _______._..Distance to nearest lot l_ne___-_____, f ---- Number _ FM of pits.----- -`._---___---Lining material !-- ------.Size: Diameter--__..l....__...___.De Dept ---- _ a --------------- P Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining ` •I Depth " I material_____.-.____---_-__.______________-_ ❑ Size: Diameter_-------~-----�:------- -- ----- _-_-:_----_--- - -� --- ---- ----------Li Liquid Capacity-------------------- ----gals. . Privy: Distance from nearest well__________________________ _____________________Distance from nearest building------------.___--____________._________- F1Distance to nearest,lot line---------------------------------------------------------------------------•-----------------------------•------------------------------------ i Remodeling and/or repairing (describe):__, _ — ----------- A ' � 6 --------------------------------------------------------------------------------------•-----•--•-----------•---------------------------...._........----- f I hereby certify that I have prepared this application and'that the work will be doge in accordance with San Joaquin County ordinances, Sta ws, a rut and regulations of the San Joaquin Local Health District. 1 (Signed) ----------------------------- --------- By: ----- (Owner an* on+rat+or) BY•----------------- --- -------- ------------------------------------------------------------------------ ----.._(Title ------------� - '------ -- ----:----- (Pio+ plan, showing f lot, Iota+ion of system in relation +o wells, buildings, etc., can be placed on revers side}. FOR DEPARTMENT USE ONLY ( _ } APPLICATION ACCEPTED BY_--!�-----------------------------------------------------------------------------------•---•---- DATE --------------------------------------- REVIEWED BY----------------------------- ,...... . ..� DATE ------------ -------------- ---- ------ - •. BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------•---------------- Alterations and/or recommendations----------------------------------- , � --------------------------•----...------------------------------------- ------- n --------------- ----- ,- ------------ ------------- ----- ��r---------�•---��;�;------�;:----------�f------�----• ------��------ - 1 " r1 1 — -� I FINAL lNSPECTIO BY: _ ! � Date. = :' S :. - --------------- 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 ES-9-2M i Revised W-2100