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APPLICATION FOR SANITATION PERMIT Permit No. ........................ (Complete in Duplicate) Date Issued __7__ '-------- J 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___ _ _ ocnz-.1 --- ------•--•----•-------•--------------------------------------------------- Owner's Name V__:..-----t-. ------ Phone Address------------- '.✓` - --------------------- ------------------------------- L -- - - Contractor s Name---- --- -------------'�_: "�------'_- - Lv-'- -- ° Phone. .! ..! "! Installation will serve: Residers Apartment House ❑ Commercial ❑ Trailer Court ❑ o�Mek ❑ Other ❑ Number of living units: __1____ Number of bedrooms __'-_-. Number of baths J---- Lot size _____ __________________________ I Water Supply: Public system ❑ 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 S' Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes [v"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p,pbGc sewer is available within 200 feet] 'l nn W� Septic nk: Distance from nearest welly_--.----.Dista Se frorr 9 nd t on.�Y___________.Mater a____.____�._._______________________ f No. of compartments-.----------�i-r--'-_Size _� --------- is -Liquid Oep'th---------- -- ----------Capacity--- -+ j----- v Dispos I'Field: Distance from nearest welll�_Yr�-Dtance from foundation "Dist nce to nearest lot ki 1W Number of lines-_- Length of each line___.________ _____f ...Width of trench------Z-�___-____________ - f Type of fiifer mate r4- Depth of filter material____.___:___--- Total length--------------/__;50_______ Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------...Distance to nearest lot line-:___.________-_. ❑ Number of pits------------------.---Lining material-----------------------Size: Diameter-----------------------Depth______.__.________________.______ Cesspool: Distance from nearest well-----------------Distance from foundation-----------:--------Lining material_____.__.-___;.____.____._____-______. Size: Diameter-------------- ----------------------De th---------------------------- ---------------Liquid Capacity ----- als. r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________.___________________.________._. ❑ Distance to nearest lot line----------------------------•------------------------------------F--•--------- ------------------------ -------------- -------- i w Remodelingand/or repairing (descr&)------- ---------- ------------------------------------------------------••-------•- :------------------------------------------------------- -----•-••--------- ----------- ------------------------------ �} _ �'` - ------------- - ! hereby certify the+ I have preps d +his ap icat" ion and that the work will be don in accordance with San Joaquin County ordinances, State I s, and rules and regulations of +he San Joaquin Local Health District. '" ` - ' ___. -----Owner and/or Contractor (Signed)- -___._._------------ ----------- ___._ 9 ---.....,. ------ ---- _ a By--------------------------------------- f...- '-------- ------------•----------------(Title)--------------------------------------------------------�=--- (Plot plan, showing size of lot, location of system in relation toZZ buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- ------------ ---------- - -------------- DATE--------------------------------- = ------ ,%% -- - t REVIEWEDBY----------------------------- ---------------I-----------------------------------+ ----------- --------..... DATE k BUILDING PERMIT ISSUED. ---------------------------------------------...-- ............ DATE-- .._._-------------------•-------- Altera#ions and/or recommendations:---- -• ------------------------------------- - ----------------------------------------------------------------------------••------------------- -----------------••--------------••----------------------•---•----------------------------------------------------------------------------------------------------------------------•--------------------------------------- ---------------------- ------- -------------------------------------------------------------- --------------------------------------------------- ---------I------------------------------------------------------------------ ------------------- r FINAL INSPECTION --------------- ---• --- Date------------- ----------------------------------- SAN ---- -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 ;��"' i95996 aTwotlO `