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' APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) /► /- AXT Date Issued ..._11_/-/-,�-__� pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. is application is made in compliance with Co my Ordinance No.��9. JOB ADDRESS AND OC I _ _ i, z c��' 1 ` ? Owner's Name ,�� --- --- ----------------------- Phone--- - ��. - Address--_-------------- .. - --- Contractor's Name------_---------------------------------------- --- - -/'------- Phone r r F -- - -- - -==--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: /_____ Number of bedrooms -„7_ 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 ❑ Nox New Construction: YesxNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ,�?Q_____Distanc e from_foundation__! Mat-eial__� ---a,__r _________No. of compartments____ Size_F/ 4�---_________.---Liquid depth------1!2----------------- Capacity._ °,_,__' '____ i Disposal Field: Distance from nearest welly{,�1-__._Distance from foundatio ----------Distance to nearest lot line___ __......... Number of lines------- ____ __ _ _______Length of each line___________ ______.Width of trench____Z6, Type of filter materia e`__ _____----Depth of filter materiaL____�, `�_---_____Total length_________ _ �rJ _______...... Seepa a Pit: Distance to nearest well_-___ _ _.__Distance from f ndation___��_______.Distance to nearest lot line__�_------ _ Number of pits---A------------Lining materia ___Size: Diameter----- `-�__-___.Depth-----. 3,�1._ ............... sspool: 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 _ Remodeling and/or repairing describe :_.__., 2 F' :�____ "_,,�_____ �� _ Z'�_. ---------------------------------------------------------------------------------------------••---.---••-----•--•----------•-- ----------------------------------..............................-----------_-------- -------------------------------------•------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State I "s, and rule nd regulations of the San Joaquin Local Health District. (Signed) ,,. ;' _ (Owner d/or Contractor) By: r .. � � (TitleJw � � --------------------- (Plot,plan, showing size of lot, location syster in elation to wells, buildings, etc., can be placed on re ars ide). RDEPARTMENT . USE ONLY APPLICATION ACCEPTED BY---_---------------- -------------- -------------------------------------------------- DATE-------- . REVIEWED BY--------------------------------------- ---- `' --------------- -------------------------------------•------------------ DATE..-- ------------------ �------------------------------ BUILDING PERMIT ISSUED................................. -------•- .....................................------------------ DATE.............. -------------- Alterations and/or recommendations:_____________________ �- /-�•-------------- ------------ 'r....... ----------_--- _______________________________________________________ -------------------------------------------.........-------------------�_j.------------------------------------------------------ r-- ----------------------------------------------------------_--------------_------------------------_-----------------------------------_--------------------------------------------------------------------------------------- FINALINSPECTION BY:_--- --=':"�.=-------------------------------------- ...... Date---- -e -1`57-------------------------- -------------- 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 Devised W-2100