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APPLICATION FOR SANITATION PERMIT Permit No. ---/--------- (Complete in Duplicate) 0 Date Issued A S-3 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 compliant it County O ,nance No. 549. ---------------- ---------- JOB ADDRESS �Y.D�IOC I N ------ ---`-----'!'- ----- ----------------------------- -------------- Owners Name -- --.6--- =II''If ----- ------------------- Phone_ _7O!Z � C1 Address------ l --- ----------- =-------------------------------------------------------------------------------------------------------------------------------- Contractor's Name �I�-----------------------------------•-------------------------------------------------------- Phone... ---------------- Installation will serve: Residence )►+ Apartment House ❑ Commercial ❑ Trailer Court ❑ _Motel ❑ Other ❑ Number of living units: _Vcommunify mber olbedrooms __�1__ Number of baths ___�. Lot size _�-.Q____x_LQ2_______________________ ' Water Supply: Public system system ❑ Private ❑ Depth to Water Table -------- ft. Loam Clay Loam Clay Adobe Hard an ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy ❑ y ❑ y ❑ p 4 Ik 1 } Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted I# ub=istapcp er is available within 200 fee .) ' Septic Snk: Distance from nearest wells!°_r__�_.� fr ffou tion�_V. -Materi IT _________________-__,___ No. of cam artments._._-__ ,��_L+1_________ ize_�- - --_x _Liquid ge�pth_�__..__.�.._._.____Capacity__ Dispos 11 Field Distance from nearest w II'! Distance from foundat:on_��_YrW.'.Distance to nearest lot lin -------------- ' Number of lines---------- -----dp-- -- ----- Length of each line----------------- tt----Width of trench.------ .-Y'- --- ----____-- - Type of filter materi 1 epth of filter material -_-____,/ - length____....___ ________________ Seepage Pit: Distance to nearest well_.___ -----------_---Distance from foundation------------------- Distance to nearest lot line----___-__-______ ❑ Number of pits-------------------1^-Lining material------------------------Size: Diameter------------------.......Depth--------------------------------- Cesspool: Distance from nearest welly______=____=•Distance from foundation-----_---___--------Lining material------------------------------------- ❑ Size: Diameter----------------- - ----------------Depth--------------------------------------------- ------Liquid Capacity- ------------------------gals. Privy: Distance from nearest well------------------------------------------------ Distance from nearest building---------------------- --------- . ❑ Distance to nearest lot line-----------------------------------------------------------------------I------------------------------------------------- ------------ Remodeling and/or repairing (describe):---------II---------_------------ --- --------•-------------••-----------•--•------------•------ U ------------------------ ------------------------------------------------- ----------------------------------------,--------------------- --------------------------------------------------------------------------•--11b -------------------------- ---------------------------------------------- -------------------------------------- ------------------------------------- -----------------------------------------------•- ----------------------------------------------------------------------------------------------------------------------------------- I hereby certify t I have prepared t ' application and that the work will be done in accordance with San Joaquin County ordinances I s a n egul ns of the San Joaquin Local Health District. (Signed). ---- ----------- - ------- --dd------------ ----------------- ----------------------------------------------------------------(Owner and/or Contractor) By:----------------------------------------- II� ------ -------------------------------------------------------------------(Title)------------------------------------------------ ------------- (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__. ' ___________ DATEr__._.___ REVIEWED BY_.. III DATE--�------------------------------------------------- ---------------------------------------------------------------------------------- �� BUILDINGPERMIT ISSUED-----------------------------•----------------------- -------- -----------------------------------._ DATE------ -*�--------------------------------------------------- Alterationsand/or recommendations-------------- 'III-------------------- ----------- ----------------------------•---------------•--------------------------------------------------- ----------- �------ ------------------ -------------------- .. .. -------------------------------••-------------------------- _-._..------------ ------- : .. -----------------------------------------------------------=------------------ ------------ ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ------------------ -- -- --------------------------------- ------------------- ------------ ---------------------------- Date ----------------•--•---- �'"'~ FINAL INSPECTION BY------------ -- ------ ----------------------- - - --- ---- ---- .... ..--� l it I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 W I'si Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodd CaliFornia Manteca, California Tracy, California ' i ES-9-2M 10-52 Revised W-2100