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_ ,. ��-�-------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued ?iiiz -'1-`` ti A plica4-ion is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5 11A t JOS ADDRESS AND LOCATIO _ -------- ------------•---=-------•----------------------------------------------------- JOB ----------•-- -----•--------- --------------------- ------ Phone -------- Owner's Name- ----------- : ---------------------------- ,� e Address------- °-••I------- -------- ---•-- -- -•---------- -------- --------------------- �f_ ---- ------------------ -- Contractor's Name----- �"(�----�`• --�-••---------- -------- € - 1 Installation will serve: Residence far+meet House [I ❑ �Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _2-'_ Number of bedrooms _ ,Number of baths—2— lot size _-- ----- --- I Private [:] Depth to Water Table ft-r Water Supply: Public system �ornmunity system ❑ y y ❑ Adobe Hardpan Character of soil to a depth of 3 feet: ;Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay ❑ p ❑ Previous Application Made: Yes ❑, No Waw Construction: Yes ❑ No 2` 7k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 100 feet.)..I �. ,. „ . v_ _.w_ - Sept'c lank Distance from neares+ well_____--_"___,___Distance from foundation _______�____.Materia____________________.________.____-"________- Size___ = - `: =_�Ligaid,dep#h--------------- ----------Capacity------------:---- --- a No. of.compartments--------------------------k Disposal Field: Distance from nearest well-_____--___=__--Distance from fouisdation____________________Distance to nearest lot line-- e Number of lines---- ----------------------- ----:Length of each line------------------------------Width of trench------------------------=---------- lQ� Type of filter material------- ----- - p ateriaL Total length _. �! .. US r Pit: Distance-to nearest well -D stance rom f unda : _ '°_.__~.Distarfce to neares# lot line___ _ ------ SeepageSize: Diameter__ De tn- I- Number of pits----- ---------Lining material p Cesspool: Distance from nearest well........---------Distance from foundation--------------------Lining .material_________________________---_________. Depth = Liquid oCapacity----------------------------gals. ❑ .Size: Diameter--------------------------- ---- - Privy: Distance from nearest well-------------------------------------- - €---Distance frome�a�resf building--'--------------------------------- ,—, _ - ------------------------- Distance -- --- ----------- ❑ Distance to nearest lot line----------------------- _ Remodeling and/or repairing tdescribes_---------------"------------ --•-----•------- ••------------------------------• = ----------------------------------- --------•----•------------ -------------------------- - ----"- ----... ------------ i----------•-----•---------------- i- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San-Joatfuin County ordinances, Sta ws, d rules d regulations of the S n Jo*_quin Local H alth District. _ • ( Contractor) _ . ---------------------- (Signed)----- r = = � -- ---------- --- By:.- - -------------------- ---------------------------------------------------(Title__. ------ ------------------------- ------------ (Plot plan, showing size of lot, locationa_f system in relation to wells, buildings, etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY_ ----------------- APPLICATION ACCEPTED BY --------------------------------------- DATE . ------ ---•--------1------------------------- REVIEWED BY------------------------------- DATE -----�'-------------------- ------------------------------ - ---------- DATE------ €5` BUILDING PERMIT ISSUED------------------------------------------- — `--------------- - Alterations ---- -- Alterations and/or.recommendations----------------------------------------------------------------------------------------------------- -------------------------- •----------------- ___________________________________ --------------------------------------________________ _ ___________.------------------._.___ ___-____-__. FINAL INSPECTION --BY:-----="------------ ---- -•------------------- T.""r Date-- _ _ = ---------------- 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-4-21v1 Revised W-2100