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J ` J APPLICATION FOR SANITATION PERMIT Permit No. --____ (Complete- in,Dup _�- - h )eate Date Issued � p �� Applicakion is hereby made to the San Joaquin Local Health District for a permit to construct and install the worts herein described. This application is mad ie in compliance with County Ordinance No. 549. �v l �o C -� d JOB ADDRESS AND LOCAT N____ ___ �:____ _______ Owner's Name-----=----------•- 1----- Y .. Phone Address-------------------------------------------------------------------------------------------- •--------------------------------------- ...........---------------------.-------------------------------------- Contractor`s Name -----•---------------------------------------------------•----------------- Phone Installation will serve. Residence.[�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __r___ Number of,bedrooms .-T-.-t1 tuber of baths ___/-, Lot size ______ ------___________ Water Supply: Public:system omm unity-system'❑""Private'❑-Dep+Vt6'Waf4r-Table## -------- ft. Character of soil to a depth of 3 feet: Sand --Gravel ❑ Sandy Loam ❑ Clay Loam ❑p Clay ❑ Adobe [2--.Hardpan-0 Previous Application Made: Yes o E] Nevi Construction: Yes4�❑' " TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tanVcr cesspool permitted if public sewer is-available within 200 feet.) } Septic Tan t Distance from nearest welL__ �1_45stance from foundation.___________.Material---------- ___________________ _._ l p I Size-- .Liquid depth p Y -� e No. of cam artments__._____ _____________Ca aeit _-. i. /. Disposal Field: . Distance from nearest well __ /'j�ystance from foundation----- _.....-.Distance to nearest lot line..__ '.__ t Length of each line d__. _."_�pC� Width of trench_____ ' Number of lines-----�iam-��,_ej(e-pepfh r g �--- ` (� �----------------- Type of filter mateof filter material____ _ _____ _ g -- -----Total len th--------- Seepage -------/--v"---------rt-------- p g -Number of pits.--.------------------Linen mate a-_7ial_7777.715 ____-,� oundation:�'�_ _Distance to nearest lot line________________ See❑a a Pit: � Distance topearest well _ __ ____g____bisfance from�f�-----Size: Diameter-------------------------Depth____________.__________________ Cesspool: Diitance from nearest well-----------------Distance fromrfoundation___________________ Lining material-----------.___.__________________.__. ❑ � Distance from nearest well ---------------------- �------• 1----------- ---- --------Liquid Capacity-------•----•---------------gals. + Size: Diameter----------------- ------ p --------------Det ------------=- ._ _----_Distance from nearest building Privy: r -------------------------g------------------------------------------ ❑ �- Distance to nearest lot•line--.--------------- I' • zi Remodelingand/or repairing (describe)--------------------------------------------•-•------••--------------------•------------------ ------- ---------.------•-------------------------------- i f ------------- l hereb certif that I have re ared this:a licafion and #hat the.. ► -= - -- ----- t -------------------- yy p p `pp work will be done-in accordance with San Joaquin County ordinancestSt e s; d rules` ndxregulat ns of the San Joaquin Local Health District. 1 (Signed (Owner and/or Contractor) w or B --------------------------------------------- --•----(Title)--- -------`-� ----- y*---------------•......_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPAR MENT USE ONLY APPLICATION ACCEPTED BY ------------- ----------------------------------- DATE-•- / ------- REVIEWEDBY--!--------------------------------------------------------------------- ----------------------------------------------- DATE--------•-------------•---- BUILDINGPERMIT ISSUED------------------ -•-------------------------------------••-----------------•------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations-------------------------------------- -- ------------------------------------------ ---------------------------------------------------------------------- ----------------------•------------------------ ---•-------------------- ------------------------------------------------------------------------------------•-------------------•--•------------------------------------ + } 9 - I �._ ------------- ---- __.._.. FINAL INSPECTION -BY:- -------------------------//---------- 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 E5-9-2M Revised W-2100