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7 : ` APPLICATION FOR SANITATION PERMIT Permit No. �J��.-3.. ►' (Complete in Duplicate) ''7 s` -� Date Issued ___ 77---------- 'ca is hereby made o the San Joaquin Local Health District for 7ap mit to construct and, inst. II the work herein described. This application is made in compliance with Co my Ordinance No. 54 . JOB ADDRESS AND L TION..__.. _.'��- :_:'_:._ " x Owner's Name--- == -•-• ------ Phone.•... �-4 ,= Address - �" �'------ :.` '`�........................................................... Contractor's Name.. - ----------------------------------------------------------------------- - Phone-_, -� "_'-."> - - Installation will serve: Residence f Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1___ Number,of bedrooms _I____ Number of baths __/-_. Lot size ------!� <.'�„�...=_"____ ________________ 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 ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No.-tl" New Construction: Yes ❑ No j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well _�.. Distance from foundation ,��!:: --.Material . - No. of com artments___ Size--,,,."..-'J` q p p ty__ __--.._----.._ p ,,,�_ _. , 1(�`�-------Li Liquid depth �_:.. ___._._.Ca aci D_isposal Field: Distance from nearest well-----------------Distance from foundation---__------_ _•-__--Dotance to nearest lot line................. Number of lines-----------------------------------Length of each line------------------------------Width of trench.. �, ' Type of filter material-------------------------Depth of filter materia----------------------- otal length.......................................... . Seepage Pit: Distance to nearest well___-----____-_---__Distance from foundation _________.......Distance to nearest lot line----_._-__---__ ❑ 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----..-_-_-•-:-__-_•_____-_-._------_--.-- ❑ Distance to nearest lot line------------------- ---- _..._ .-.______. ` . R odeg and/or repairing (descr e) (� -•- - - _ ...-- --� _ r---- •- ----------- --- ..................... -•-- - ---------------------------•- . I .hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State;Ia� and rule nd regulations of a San Joaquin Local Health District. r 2 - Si ned _____ ________ _._...(Owtiier gn�/-or Contractor) r ' r.. B ! --• ---- = (Title),--- y = Y (Plot plan, showing-she of lot, location 64 system in relation to wells, buildings, etc., can be Placed on reverse sidQ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----------------- -----------_- ------. DATE._ ...,? +' --------------- REVIEWED . I/ . -----•-- ------ . REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE-------------- -------------------- BUILDINGPERMIT ISSUED...................................................................................................... DATE----------------------------------------.-------------•---- Alterations and/or recommendations:--------------------------... R -/- •---------- --------------------------------------------•--------------------•------------------ -------------------------------....... ------......------ �+ 4 ..:_. - 1------................. ---------- --------- -------- ---------------------••---• •------------ ----------1 ---.......��------------` -- ! -------- ---------------- ---------------------------------------------------------------------------- ------- ----------------- •. ••-----•-•----••-----... ••• .. . ----------------------------- ...................................... f FINAL INSPECTION BY:.. f� 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 10-52 Revised W-2100