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APPLICATION FOR SANITATION PERMIT Permit No. ...�r________________ { (Complete in Duplicate) Date Issued ------------ -------- Applica*ion 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. a - = - JOB ADDRESS AND L CATION-__-__----- -��.`--�---------------S--v_-_ IV I '/1/�('� -- Phone------------------------------------ ` s Owner's Name -4--------------------- = -- - I Address-----------Z7Z-�-��----------------ZV---------��------ ---------------------------------------------------- Contractor's Name---'f 1=E d �4 -cs Phone. G -c�_7 Installation will serve: Residence [;� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ /Other ❑ Number of living units: -- -__ Number of bedrooms __umber of baths._-- -- Lot size _---- - _-X----�J- Water Supply: Public system K) Community system ❑ Private ❑ Depth to Water Table -57� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe Qr Hardpan ❑ Previous Application Made:- Yes ❑ No (X New Construction: Yes ❑ No TYPE OF INSTALLATIONN-AND SPECIFICATIONS: (No septic tank orrccesspool permitted if public sewer is available within 200 feet.) Septic Ta �-'r�J ,� , �ntG6f compartments artmen}sr well----------------Distance from foundati�q�i�--�eps.---Material:-----------------------------------------------. ❑ l p th--------------------------Capacity----------------------- �:i, Disposal FId arae from nearest well------------- Distance from foundation--------------------Distance to nearest lot line--__----_-_----_- ❑ . t Num er of lines--------`,------------------------ Length of eachline---------.--------------------Width of french____-•----------------------------- Type of filter material--------------------------- of filter material-----------------------Total length--_----------__--_-__----______---------- Seepage Pit: """Distance to nearK. est well 44/ Distarsce from found ion---- '.f......D�s ani to nearest lot line ----------- Number of pits.-_-----)---_-------Lining material--4 z -- G ze: Diameter--__ __------Dept h--------_�, -- - t �. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----_------------------__----_----_ ❑ S;ze: Diameter-------- --=-------------------------Depth-------------.---------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------- -----------------------------------------Distance from nearest building------------------------------------------ F1Distance to nearest lot line---- ------------------------------------------------------------------ ------------------------------------=-------- Remodeling and/or repairing (describe):----------------- ----------•----------------------------- ---------.- ------------------------------------------------------------------ ------------ --------------•-------------------------------------•--•-----------------------------:---------------------•--•------------------------------------------------------ ---------------------------------------------- - I hereby certify that Fhave prepared this application and that the work will be done in accordance with San Joaquin County } ordinances, State aws, and rules and regulations of the San Joaquin Local-Health District. d 11�� .------ --- ��i -= - ____Owner and or Contractor (Signe ) ---------- - - ------------------ ( / ) By:---- --------------- --- � -_----- ------------ ------------------(Title)-------- - (Plot plan, showing size of lot, location of system in relation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY q APPLICATIONACCEPTED BY--=--------- �" - ------------------------------ ---------- -••--•----- DATE------7-----•--------------------------•------------- REVIEN D BY----------------- --------------- ---- -------------------- DATE ; REVIEWE G PERMIT ISSUED--------------------------------- DATE------------------------ ------------------- Alterationsand/or recommendations--------------------------------------- ------------------------------------------------------------------------------------___---------------- ----------- --------------------- ---------------------•---•----•----- --------- ---------------------•-•-•- -------------------. -- ---------------••-----•---------•-----------------------•--------------•------------------------ ---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- .-...---------------------------------------- -----•---------------------------------------------- ------------------------------------------------- --------- ---------------------------------------------------------------------------------------------------------- -------------------•---•- -------------------------------- -------•------- ---- ----------------- - -------------------- -=---------------------------------------------------------------------------------------------- FINAL INSPECTION BY:: =------ Date-------- -- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oafs Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100