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QQ � • �'� R• APPLICATION FOR SANITATION PERMIT Permit No. __S' ___- 5� (Complete in Duplicate) Z41) Date Issued ____ � ( c pplication 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 withCountyOrdin ce No 549. JOB ADDRESS AND ATION._._ __1_ ,_/__'� ` �'M`- / - - ---------- - Owner's Name -------------------------------------------- Phone A Address-- �� --- - -`- f ----- ---- ,� , . Contractor's Name_____ ____________________ Phone__ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Cc irt ❑ Motel ❑ Other ❑ Number of living units: _ ____ Number of bedrpom .__, Number of baths _____ Lot size _-_ S _,f ----- --- a__________________ _. Water Supply: Public system 4--'Community system fl Private Depth to Water 1 able ________ ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy 'arq ❑ Clay Loa'r�jt❑ Clay ❑ Adobe Hardpan ❑ Y Previous Application Made: Yes ❑ I o El New;'Construction: Y ❑ No ❑ 11 TYPE OF INSTALLATION AND SPECIFICATION Si (No septic tank or cesspool permitted if public sewer is avai' within 200 feet.) Septic Tank: Distance from Weariest we I_ Distance fro un ation p I Material- -`z' � No. of compartments---� ---------i-------Size---�1 -- $-----Liquid dep h---------'----------------Capacity - -- ---------------� -7d Disposal Field: Distance from near t well 7 __.Distance from-foundatio •.1___ _ _-Distance to nearest qllot line--- ------- Number of lines_ __,,__,,_��___ _ Length of ea h line.__ d_ __. Width of french.__�rt_-------------------------- Type ______________________•_Type of filter material_'__ ._Depth of filtr material_____ _- .__-Total length-----44j------------------------ Seepage Pit: Distance to nearest well-----------------------Distance froil foundation___________________.Distance to nearest lot line----------------- ❑ Number of pits-----------------------Lining material-----------t-----------Size: Diameter------------------------Depth-------.------------------------- Cesspool: Distance from nearest well-----------------Distance fro' ♦foundation_____ ___ -----Lining material----------------------------------- ❑ Size: Diameter '------------------ - Depth ' ----------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest wei(=--------------------------------_ _ _ ____Distance from nearest building------------------------------___________- ❑ Distance to nearest lot line-------I----------------------------------------- ..- "'-------------------------------------------------------------_----------- a Remodeling and/or repairing (describe):---------- ---- - ----- - ---------------•--------------------------------------------------- - --------------------------------------------------------------------------------------- ------------------•--------------------------------=-------------------------------------------------------------- ---------------------------------------------------------------------------------------= ------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepaged this app) ation and that the work will be done in accordance with San Joaquin Count► ordinances, State 6ws I and rules d lations ol the San Joaquin Local Health District. 1 (Signed)------ " ' f - i .�� r. --------------------- ----( and/or , 'ntractor) B •--------- ------s��.-� � ) - -- ------k Title ancl/or,��ntractw) (Title)t ( ) (Plot plan, showing size of lot, location pf system in on to wells, buildings, etc.; can be placed on reverse side). FOR *PARTWENt USE ONLY APPLICATION ACCEPTED BY____________ ____ _ ________ DATE_____--__----`"--____----, ,. REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE-------------------------•---------------------------------- BUILDING PERMIT ISSUED------------------ DATE------------------------------------------------------------- Alterations and/or recommendations---- ---------------------------------------------------•-----•-------------------------------------> --------------------------------------------------- --------------------------- ------------------------ --------------------------------------------------------------------------------------------------------------•---------------------------- ------------------------------------------------------------------------- ------------------------------------------------------------ ---------------------------------------------------------------------------------------==---------------------------------------------•------------------- FINAL INSPECTION BY-------------- -------------------------------------------------- Date----------- /-----�0?'/.-__-_________---------------------- 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