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APPLICATION FOR SANITATION PERMIT Permit No.X .�-��-�-- ( Ay Sli D i l Compete n Duplicate) 3 y -y Date Issued ._... y/ Agc 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 Coun�-t-y7 Ordinance No. 544. ------------ --------- ----------------------------------- --------------- ------ JOB ADDRESS AND LOCATION _D --f. Owner's Name----- --- --------------•----- ------------------------------------------- Phone-------------------.._....-._ Address.......J-_2l------_---.?------- ------------- - ------------------------------------------------------------------------------------------------------------------------- Contractor's Name---- - ------ •------- -----------------------------------------------------•------- ------------------------------------------ Phone--------------------------..--•---- Installation will serve: Residence 5�_ Apartment Douse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1------ Number of bedrooms _:I-____ Number of baths --I----- Lot size __`3_' _y,__ _S ____________________________ 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 p Adobe Ejj�Hardpan ❑ Previous Application Made: Yes ❑ Noo15V New Construction: Yes No ❑ 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!Q_..__Distance from foundation.-.4d-------___.Material_� ___� __ No. of com artments---- - Size__ X •�__ 'r_ Li uid de th_______ Ca acit _ I' et- ------ K--- q p. ----- P y• -------- Disposal Field: Distance from nearest well-_Il- . Dista ce from foundation---1ti__._____._.Distance to nearest lot line__s�___-------- Number of lines__________ _______ _________ Len h of each line_________�.._0-----____-Width of trench__ . _ ..___________ Type of filter materia_____ . _.__--G-_. of filter material------�.�...�__---Total length----- ,___19____________________________ Seepage Pit: Distance to nearest well---------------------- from foundation-------------..----.Distance to nearest lot line----------:______ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest weld-----------------Distance from foundation----_...------------Lining material------------_------.___-----_________ ❑ Size: Diameter---------------------------_TT___Depth-------------_.-----------------------------—-----Liquid Capacity-----`_--_fir___—____gals. �+ Privy: Distance from nearest well--_-_______________________--------_-------_....Distance from nearest building____________-_______-______________ - ❑ Distance to nearest lot Ii - ----------------------------------- ------------------------------------ t -------------------------- ----=-� -----•0.0-------- -- Rem eGng an /or e firing (describe • _ .-_._ ._ -- ._-.-.-.. ------------- =`.�----------- ------ - ---- ........ - ----- --- -- ------- - 3,� _ `L e 4��-i t.J :SL -------------------------------------------- --------------------------------------------------------- - ------- ---------- - - ----- ---- - ----- ----- I Hj___ ify t t I have repared this application and that the work will be done in accordance with San Joaquin County ordinanla s„and es nd regulations of the Saiz Joaquin Local Health District. (Signed �.... - ---------------------------------------------------(Owner and/or Contractor) ----- --------------- ---------------------------------- ---------------------------------------------------------(Title)_- -•---------------- •- - ------------------------------- ------ (Plot plg size of lot, ation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -------- -------�'�" - _ DATE--------- --------------- ----------------------- ------------------------------------ REVIEWEDBY---------------------------------------------------4' ------------------------------------------------------ ---• DATE--------------'- f ------------------------------- BUILDING --- BUILDING PERMIT ISSUED �� ------ DATE _. . - - Alterations and/or recommendations:---------------- -----.-..------------------------------------ ------------------ ------- - - - ------=--- -------i__,---•-- - ” _ - rte- - .-- --------- �,1- ------ -------- -------------------------------- --------------- ------------------------------------------------------------- ----------------------------------------------------------------- --------------------------•-------------------------------------- .... ..------ --- --- ----- ------- -------------------------------------- -------- -------------------------------------------------------------------- FINAL INSPECTION BY:- ---- _----- ----- - `�r''L-�----------• Date---- �� Z/ ------------------------------------ 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 745446 ATWOED 12.54