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APPLICATION FOR, SANITATION PERMIT Permit No. ._�Q Q1� l� (Complete in Duplicate) - Date Issued ____ Applic&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. 541. JOB ADDRESS A LO ON_______ __� �4-__ _______ ____ ____ �. r-�' --_�t------------------------------------------ ------------------------------- Owner's Name- --------�= ..,_.. ... -- ------------------•---------------------- ----------- Phone--- 3 Address----— ------ - ----------------- Contractor's Name ------- ---------------------------------------------------••--------------------_-- Phone_. T.__49-� Installation will serve:r Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ------ Number of bedrooms __ Number of baths .-J-. Lot size _1;_� -------------_____________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table��_- P_ ft. 3 ' Character of soil to a depth of 3 feet: "Sand E❑ Gravel ❑ Sandy Loam E❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ tPrevious Application Made: Yes ❑ NoNew Construction: YesV No ❑ / \ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- ! No. of compartments ----Size----------------------------- p __Liquid depth--------------------------Capacity 1 Disposal FieDistance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- % . 7. Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material________________________Depth of filter material-----------------------Total length------------------------------------------ Seep ge it: Distance to nearest well___ _ __________DistanA�omndation__/l0_...___.Dis�ance to nearest lot� ---Size: Diameter---Number of pits----�----------- --Lining material 3_____._._-------.Depth_ a a -- - - w Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material---------___-__- -,_.__-----` _ i, ❑ Size: Diameter--------------------------------------Depth-------------------•--------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well________ _______________________________________Distance from nearest building__{_____--_____________-----___-_.___._- ,❑ Distance to nearest lot Fine------------ -----------------=--- ---------------------------------------------------------------- } Remodel g and/or repairing escribe):--4 _ -- - .•� ' -- ------ ------ ------------------------- - - -------------- -- ----------- - •----- .--------- ;.,• --------- ----- ------------ -- -------- - -------------------------------=----------------------------------------------------------------------------- I hereby certify that I have pre4red this application and that the work will be done in accordance with San Joaquin County ordinancesW?efe�laws,- d es and r u tions of the San Joaquin Local Health District. (Signed)----- --------- .� (Owner and/or Contractor) --------- ----------------------- •- --------------------------- BY� � - - ---------------- ---------------------------------------------------------------(Title �a "e' -- - -- ---- -------- plan, sho ng size of lot, location of system in relation to wells, buildings, etc., can be placed on reveee, side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- �-„ - , 63 - DATE '� a REVIEWED BY ----------------------- -------- --------- --- --------------------•----- � DAT - BUILDINGPERM IT=ISSU ED---------------------------------------•--•------------------•------------------••------------------._ DATE-------------------•-------- --------------- Alterations and/or.recommend ations:-------- ......... -- ------------------------------------------------------------•----..-------------..---------- ----------------------------------- t ----------------•-------------------------------------------------------- ------------------------------------------------------------------------.---.----------------------•-------------------•---------------- ------------------------------------ -------------- ----------=----------•----------------------------------------------------- -----------------------------------------------------------•----------------- ----------------------------- ------------------------------- -....---••---------------------------------------------------------==-------- FINAL INSPECTIONDate v+ JOAQUIN LOCAL HEALTH DISTRICT p.. 130 South American tStreet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California /ES-4-2M Revised W-2100