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APPLICATION FOR SANITATION PERMIT Permit No. ..... p (Complete in Duplicate) Date Issued �e-vj4/`�s' Application 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. 2 � JOB ADDRESS AND LOCATION------------- G 4 ... '- �' { Owner's Name----•--•---- -/&..---e•....... -- ,'S`8-�r+,-'!-------------------.- Phone-_e' 0---------- e _ Address------------------------------------------------------ z ,-- . ---------------------------------------- ---------------- rr Contractor's Name................................... --- ----- -------------------------------------------- Phone__- ---1�---�?_0,7---- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .1------ Number of bedrooms __Y Number of baths -1._-__ Lot size ______31 ____f ------------- Water Supply: Public system ❑ Community system ❑ Private;g Depth to Water Table ------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay F] Adobe ( ' Hardpan ❑ Previous Application Made: Yes Q No,& New Construction: Yes ❑ No ❑`K,. TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Ta k: e - Distance from nearest well-----------------Distance from foundation--------------------Material___.----._--_-____.--.---_-_.-----.--.-- _---_. �..- No. of compartments--------------------------Size-------------------------------Liquid depth-------------------------.Capacity-----------------------� osa! i t: Distance ffom neares well__c' �-Distance from foundat�._/'.....Distance to nearest lot line__ rf� Number of lines------------- r__�`. _ .__--Length of each line__-- --�0_�_-- --------- ... of trench.-�-�_/_.__.__----------- r , -t Type or filter material__lrJ _____ -_--Depth of filter material--------f0---------Total length-----J Q__ _________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material.._.____- _--_.-.___Size: Diameter-----------------.-----Depth--____.--._____________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------.-_.-- ❑ Size: Diameter--------------------------------------Depth----•---•----------------------- ----------------.--Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line---------------------- ---------------------------•-------------------- --•--------•----------------------------------•-------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ ------ --•--------•-•--•--•---------•----•-•---------------•--•------••---•-••----•-•---•----•-- ---------------------------------------------------------------------------- ---------•--------•-------•-------------------------- --------------- - --------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- I hereby cert y that I ave pre a d this app ication and that the work will be done in accordance with San Joaquin County ordinances, Sate ws, an ules an r gulations th an Joaquin Local ealt District. �0 (Signed)........ ----- -- -- --- ------------------ --------- --- -- - ----- ------------------------------•----- Contractor) C - ---- -- --=- - ----- ------ -(Title)..- -- -- - �-�-. �._ p�__-:c.._.�'_.---------- (Plot plan, showing size of lot, location of system in rely on to wells, buildings, etc., an'be pla a on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------•--- --------- ------------------------------------- DATE....................... ----------------------------- REVIEWED BY--------------------------------- -- �'� DATE_ � • 'tt -- ----------------------- BUILDING PERMIT ISSUED. -- --------- ------------------------ -•------------------------------------------------- DATE------.--------------- Alterations and/or recommendations----------- --------------- ---------_------ ---------------------------------------------------------------•--------------------------- ................. ----------------------------------------------------------------------------- ----•------------------ ---------------------------------------------------------------------------------------------------------------------- ------------ ----------------------------------------------- -----------------------------------------------------------------------•--------------•------------------------------------------------------------------ ----•-----------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------- ---- -.-.-_ FINAL INSPECTION BY-------------------------------- ----------- Date-------- p.------- -..l --------11 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