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' `'VPermit Na. I- APPLICATION FOR SANITATION PERMIT ` (Complete in Duplicate) / Date Issued --------------�- Application is hiereby 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----- - -� ---- --` --a------- 4---------------------------------------------•--------------------_----------- Owner's Name --------- --- - ---- r ---------------------- ------------------ Phone--- � - ---------- Address------------------ � Contractor's Name -'1 --------------------------------------------------------- Phone-------9.`W_#.7---- Installation will serve: Residence fig,, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1-_- Number of bedrooms _ _._ Number of baths I___ Lot size -� ----------------------------------------------- .----- -- �� Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ ' Previous Application- Made: Yes ❑ NOIK New Construction: YesXNo ❑ 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 foundation_ _______Material_ �_ �_ -"_ No. of compartments_ .�------- ---------Size.J � ......Liquid de th___e" " .......Ca acity--5! % -� -------------------- Disposal -- -- -- Disposal Field: Distance from nearest well_df__V.__-_-Distance from foundation_-_-_ _Distance to nearest lot I' e.__ 41 Number of lines---------_.__--r__--- . Length of each line__/4+ --— ___-_-_ Width of trench_._. _�-_______________ � ! Type of filter material____ X_._.. _Depth of filter material----._1 _`4.___Total length___.__ -�----- .._ W Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____...__.._____ ❑ Number of pits-------------------.--Lining material_ ._s---_--.-------.Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest wefl-----------------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-------------------------- -------------------- ----------------------------------------------------- --------- ------------•--------------- Remodeling and/or repairing (describe);--------------------------------------------------------------------------------------------------------------...........------------------------------- -------------------------------------------------------------------------------------------..--•----------------------------------------------------------------------------------------------------------------------------- ,C� --------------------------------------------- ----- ---------------•-----------------------------------------------------------=-•-•--------------•---•---------------------------------------------------------------- ------------------------- ---------------- ---- -------•----------------•----•-•-•-----------------------------------------------------------------------•-------------------------------- 1 hereby certify tha I ve prepared the I plication.and that the work will be done in accordance with San Joaquin County ordinances, State I n rules and regulatio& of the San Joaquin Local Health District. r � (Signed)----------------------------- - �4')l .... -- � Contractor) B : - Title i '.-- ,a...y { } {Plot plan, showing size of lot, location of system in rel t' n to wells, buildings, etc., can be laced on reverse side}. FOR DEPARTMENT USE ONLY �`// APPLICATION ACCEPTED BY---------------- ------------------------------ ------------ --------------------- DATE------ = {� b�' A-------------- REVIEWEDBY---------- -•----------------------------------------------------------------------------- ---------------------------------- DATE---•----------------•-------------- --- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------------------- ----------------------------------------------------•----------------------•---••------------------------------- -------•-•-----------------------------------------------------------•- --------------------------•-- ---------------------------------------------------------------------------------------•------------------------------- r i FINAL INSPECTION BY--------------- - -v- - --- ------------------------ Date--------- --- --�1 ------ 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 10-52 Revised W-2100