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t ` APPLICATION FOR SANITATION PERMIT �< Permit No. �. (Complete in Duplicate) �/ 4 Date Issued ___�JfC'-'`/_I__�_ i Applica{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 County Ordinance N . JOB ADDRESS AND LOCATION__4_ D —` - ------ -------------- -- Owner's Name-- - --------------- --------------- Phone.-----------------------------•----- Address. - -•------------------•--------------•-------- ------------------•-----------------•------------------- 4 ---•--------------- �r�� -� Contractor's Name--- ------•- '" ---------- t Phone�Tt-a._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: L ---- Number of bedrooms .� Number of baths {----- Lot size _____.a------./r----1--�--`�--------------- Water Supply: Public system ommunity system ❑ Private &-Depth'to Water Table50- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ff--H�n ❑ Previous Application Made: Yes ❑ No dew Construction: Yes ❑ No 29-- 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------------------.-_----_-______..___...__.__. 3 No. of compartments---- - -------------- -Size------•-------------------------Liquid depth-- -----------------------Capacity----------------------- isposal Field: Distance from nearest well- ..V_-- Distance from foundation___._ Q-�---Distance to nearest lot line___ Number of lines_______.___ Length of each.line_____ �.$.____�.__.._,Width of trench___._ r rr r------------- _ Type of filter material--/' See of filter material-------�g------Total, length______-:�,�---______________________ Seepa a Pit: Distance to nearest well_l ! Distance from fou dation___ -- 0----.-_ Distance to nearest lot line___�L�_---_ Number of pits------- --------------Linin material.-- -----------Depth--__--.� Lining /�" _ .Size: Diameter_ �------------- Cesspool: Distance from nearest well---_-------------Distance from foundation-----.--------------Lining material__..____..__..._:__-------__________. ❑ Size: Diameter------------------ ------------------Depth-----:-------- ------------------.---.-Liquid Capacity----• --------------------gals. rQ Privy: Distance from nearest well ___--------------------------------------------Distance from nearest building_-___________._------_______.._--.--.-.-- Distance to nearest lot line- --------------- ----------------- ------- - ---•--___----------------- ------------•-------------------------------------------------------- - Remodeling and/or repairing describe)-------------------------------------- -----•--------...-----------------••-- ----------••-----•-------------•---- ----------------------••--------•---• N --------------------- --------------------------------- ----------------•---•------------------------------------•-------•--------------------•-----•-••-------•-------•------------•-------------------------- ----------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanceM.SSfate'lls, and rules and regulations of the San Joaquin Local Health District. ----- s Contractor) Ss ned( ig )• - -- 1 gY� - ------------------------------- (Title( (Plot plan, showing size of lot, location of system in relation to wel[s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------ -•--- - ----- - ------- ------------ --------------------------- DATE---- ------------------------------------------- REVIEWEDBY--------------------------------------------- ---- ------ -------------- ---------------------------- DATE BUILDING PERMIT ISSUED----------------------------------- --- DATE---------- -------- ------------ Alterations and/or recommendations:_........................ -.----" -_.._..� � -- --•------ --•------------ ----------------------------------- -------•----------------- ----------------- FINAL INSPECTION BY:. -------------.. --�-------- ---- ---------- Date.-------- ------------- ------------- - ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t3o 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 145446 PTWCoD 12-54 t