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1 APPLICATION FOR SANITATION PERMIT Permit No. �------- `� (Complete in Duplicate) Date Issued Application 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 o. 549. :!2e,05ee- -------- ---- ---------------------- ESS AND ��, ATIOAA_____'J OB ADDR �----- -------- Phone ----------------1 Owner's Name______ + - ------- ---- ._ _ ------------------ Address--------- . _--E Phone- Contract ho ns_ Contractor's Name -------------------- ----- Commercial Trailer Court ❑ Motel Other ❑ Installation will serve: Residence!Apartment House ❑ ❑ Number of living units: __.l__ Number of-bedrooms ._J__ Number of baths __1___ Lot size __ ��1 d Water Supply: Public system Community system ❑ -Private E] Depth to Water Table. ff. I Character of soil to a depth of 3 feet ❑'Sand ❑ Gravel ❑ Sandy Loam Clay Loam [I Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Nog- New Construction: Yes No ❑ FHA/VA: Yes ❑ No-T 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, Dista in e�fro foundation--- --------Material-------_ ____ _ No. of compartments- 1-9------•-----------Size-4--------=--- ---------Liquid depth_- - -3------Capacity..-- ___ Distance from foundation __ Distance to nearest lot li Disposal Field: Distance from nearest wel - f Width of trench------ in Number of lines-----/------------------- ----Length of each line____-- ------------------------ Type of filter material_. _-__ ______-Depth of filter material___--�-�--- ----Total length--------_ ____U�---_-----------� �i Seepage Pit: Distance to nearest well' -----Distance from f ndatio -..Distance to nearest lot line____- --.Size: D' eter ---- - F--r-----De to--_� � • _ _Lining materia �- - �'�( Number of pits__---- _ ---- � p '� --------- �"' ------- - -- ing Cesspool: Distance from nearest well________________Distance from foundation._._---------- ---�L�nuid Capacity - gad ❑ Size: Diameter Depth -------------------- q p y-------------------------- I -� - ----------------Distance from nearest building-------------------------------- -------'"� Privy: Distance from nearest well-__.__--_.___------------------- ❑ --- Distance to nearest lot line----------------------------- ---------- - --- ------------- ( ----------------------- -------------------------------- Re �in and/ r repairing (describe : ---------------------------------- --------- -------------•- ----------------------------- L .__p_ ________________ ._____.__ --__e _ ____.__________._____________________________________________..________- - a �---- - / ---------- ------------------------------•---------------------------------------•--'--------'----------------------'--- r � G I I hereby certify that I have prepared this application an t�ha+ the work will be done in accordance with San Joaquin County ordinances, State laws,-and rules a r uIa+ions o he S Joaqui acal Health +rict. ----- -- -------------' --- ----------------- I (Ow r Contract --- �o or I. {Tiel'oaced - --------------- - �y. tion of system in.relation to wells, buildings, etc., can on reverse e). F (Plot plan, showing size t, location I FOR DEPARTMENT USE ONLY I ----------------- DATE----------- I `---��-- ---------------------- APPLICATION ACCEPTED BY-----r�i-_-��-'�--r---------- ------------------- ------------- - REVIEWED BY----------------------------------- ------ -•----------------------------------- ._ DATE---------------------------------------------------------- t BUILDING PERMIT ISSUED--------------I------- ------------------------------ DATE------------------------------------------------------------ - --------------- Alterations and/or recommendations: . __. - -- ----------- ---------------------- ---- - ----------------- I = � � �E_-Y --------------------- 44, ------` '� ,_ _a.----------- ` ?�`P v �------------ --- --- - ---- - ------ -------- - --------- ---------------------------- t - ----- ----------- ---------------------- ------------------------ - --------- ----------------------- - -�.� _ :: ------------------------ - k - I ., . -------- Date----- � ---- -------------------------------------- FINAL INSPECTION- BY;------- - I I SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Stree4 814 North "C" Street 130 South American Street I y. Trac California Stockton, California Lodi, California Manteca, California ES-9-2M , Revised 1.57 F.P.co.