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,`. , t APPLICATION FOR SANITATION PERMIT Permit No.` (Complete in Duplicate) �- Date Issuec��. 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. JOB ADDRESS AND LOCATION-----•--•- `3y ="1---•-------------- --------------- ----------------------------------- Owner's ------ ------ ---------•- - t Owners Name---------_----------------- •- - ----- ------------------------------------------------ - ------------------------- Phoned" - ` Address-------------------- ------------- - •-------------------------- - Contractor's Name------------------- -r...-' ---- ----- --------------------- •------ -------- - ------ Phone-- -------------- ...----- Installation will serve: Residence gal Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Y Number of living units: a ..__ Number of bedrooms.,-____ Number of baths ____ Lot size 11y................................ 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 E] Adobe UT`kardpan t' Previous Application Made: Yes ❑ No Flew Construction: Yes ga—lq_o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; !aa -__.Distance from foundation____ i ` Septic Tank: Distance from nearest well-,! _ �4-_----------Materia' ---✓"-""'-- __ No. of compartments-------2C------------Size...jo!,,,,�frt"'�C:�'_-li1_.-_-_Liquid depth____" _ Capacity__ _.__: Disposal Field: Distance from nearest well-100'----- Distance from foundatio Distance to nearest' lo i e Number of lines--,..__.____ Length of each line-Apo ti T --Width of trench.-'� 7 s Type of filter matei _ Depth of filter material---1 ---------------Total length..... Seepage Pit: Distance to nearest well-____________________Distance from foundation...................Distance to nearest lot line_____:________.:. ❑ Number of pits----------------------Lining material_-.--------------------Size: Diameter------------------------Depth_________ - ___-_____ r Cesspool: Distance from nearest well-----------------Distance from foundation _________________Lining material---------------- Size: ___ -_-- Size: Diameter- ----------------------------------Dept h------- --- ------------------------ - - ---._Liquid Capacity g Privy: Distance from nearest well______ _______________ _______ __,_-_______Distance from nearest building-------------------------------------- ❑ Distance to nearest lot line----- -- ------------------- - -----------------------•-------- -------------------- ---------- ----- Remodeling and/or repairing (describe):__-____ --------------------•-----------------------------------------•----------------------------------------------------------------------------------------------------------------------------- ----- - --•-- --- r �_. --------------------------------------------------------------------------------------------------------------------------------------•---------------- ------------------- ------------- -- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cour ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ( 9 .��y. ... . ' --------------- ----- ----------------------- -----(Owner-and/or Contract x : , y BY--------------------------------- -------------------- -------- -------- -------- ---- ------(Title)-=---- --.............. -----(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----------- - - ----- DATE-. ------ ...... BY- ----------------------------Z. if - --------------- DATE �0...... �----- . . BUILDINGPERMIT ISSUED......................................./ ----------- ----------•---..._..••-- ---- --- DATE--------------- ------ .............................. Alterations and/or recommendations------------------------ ----------------------------•----------------------------------•---------------------------------- -------------- --------------------------------------- -- ----- ---- -- ------------------ - - - 9 FINAL INSPECTION BY:......... •---'-- r 2_e1_ -------- 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-9-2M 8-51 Revised W-2100