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y APPLICATION FOR SANITATION. PERMIT 1,0°—,mit No. r (Complete in Duplicate) (e Date Issued Applical1on 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--------------� 7--------- � L" -- ----------------- Owner's Name--------- -•----- y ------ ----------------------- ----------------------------------- ---------- Phone--•-•---•------------••-------•-•--- Address------------------------•-'--------------------------------•----------- Contractor's Name------------------------------------------------------------- --------------------------------------------------------------- Phone-_..Phone-_..__.....-------------- Installation will serve: Residence [ +T� Apartment House,,[-] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f Number of bedrooms __'Number of baths I-_-- Lot size --------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 F] Clay E] Adobe Edardpan ❑ Previous Application Made: Yes o [( New Construction: Yes 9_1<ID r 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--�� -------------- h � N r (� No, of Compo'tments_________.._....__size_ � _�.�_ J�__Liquid depth__.__-_ a_:_- Cap icity______:__d-__-_- D•+sp sa Field: Distance from nearest well_______ _____Distance from foundation ____fd._..__.bistance to nearest lot line_____! _... Number of lines______YO}�'_-3___ Length of each line_______j�0__'`._______-Width of trench-_-.-______ .`�___._______ Type or' filter mai _04-i -Depth of filter material-------- _____.Total length______________ Seepage Pit: Distance to nearest well-----_----------------Distance,.from foundation-------------.......Distance to nearest lot line----------------- - - ❑ Number of omits___-- __ Lining material---- ------- -.Size: Diameter ._--- Depth F s — Cesspool: -Distance fi.omgnearest,�well __.Distance.,from..foundation __ Linin m material------------------------------------- Size. � _ ❑ _ .yam ,w.o ;�.+.;,.,,.�Liquicl'CapaafY 9a1 Size: Diameter De th =- - --- Privy: Distance from nearest well--------- ----.- __Distance from-nearest building___"________________________ ------------- ❑ Distance to nearest lot line-----------------------------------------•---------------------------------------------------------------------------- ------•---------------- Remodeling and/or repairing (describe)--- ------ ------------------------------------------------------•---•-----------------------•-•--•-•-------------------•-••---- -----•------•-----•--------------------•-••----•------•-------•---------------•------••-------------------•-•-•---•--------------------------•---•---•--------------------------•--------------------------•------ ----- - ------•--- -•--•------ ----------------------------- -------------------------------------------------------•-----------•---------------------------------------------••-------•- -------------------------------------------..------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 'ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. 7 (Signed)---=---------- 1 ------4Y ' C► ..v..Qr.1......---------•------- •---- ---------- --------------------------(Owl er and/or Contractor) BY:------------------------------ ----------------------------------------(Title)----------------r----------------------------------------------- (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---------------------- �, A --------------------------------------------------- DATE------------ -t --/�-- REVIEWED BY- - ------------------------------------- --- --------- ----------------------------------------------------- DATE-----------------------------L BUILDINGPERMIT ISSUED----_-_-------------------- --------------------•--•-----------------------------------•-- DATE------------------------------------------------- Alterations and/or recommendations----------- -------------------------• ---------------------------___--------------------------------------------------------------- ------ -------------------------------•------------------------- --•-•- ---------------------------------------------------------------------------------------------•-••----- •--------------------------------------- -----------I--------- ---------------------------------------- ---------- •------------------_-_.___-_----____-_._,_-______________________________________________w__.__.________.____._____________•____,__-___--_._________________________..________._-_-.---_._____________.___--_____._________ ___________________________________________________________________________----------- --------------- --..--_._-._________..__.___..._________________.___i_-._--.-.______._.___-___---_-..-.._________._--_- ••. FINAL INSPECTION BY---------------- -------- Date-------2--..-��.----- ---- ---------------------------- 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 4 ES-9-2M Revised W-2100