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71�1 I SANITATION PERMIT Permit No. 5 APPLICATION I;OR SA q (Complete in Duplicate) Date Issued _--.j--"y + _ made to the San Joaquin Local H Ith District for a permit to construct and install the work herein described. Apphca ion is hereby q This application is made in compliance with County Ordinance No. 544. . rµ ` jIf Phone Owner's Name_JOB ADDRESS AND LOCATION.. ------1' l - - ------------------------------------ Address --------------------------•------------------------------------------------•---------- --------------- ----------------------------R i r]� f.� Phone----------------------------------- Contractor's Name----------------------------------------------+Ct✓------[� �-� --- ----------------------------•------------- ------------------ Installation will serve: Residence E Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ # i j Number of living units: _----__:Number of bedroom' _. Number of baths ---------Lot size ............. Water Supply: Public system t Community system i®illi Private E] Depth to Water Table __....._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ i.. f I Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: No se tic tank or cesspool permitted if public 'ewer is available within 200 feet.) .y.. Septic Tank: p Distance from nearest well.............. Distance from foundation._._......_........Material------------------------------------------------ ❑ No: of compartments Size--------•---------------•-------Liquid depth--------------------------Capacity-----------•----- --- Disposal Field: Distance from nearest well_.....:-....... _ Dis+ante from foundation----------------_..Distance to nearest lot line----------------- Type of filter matersal-------------- ----- - Length of each line-----------------------------.Width of trench----.-_:--------•------------------ ❑ " Number of lines-------•------- ---= ------------ -Depth of filter material------------------------Total length----------------------.------------------- Seepage Pit: Distence'to nearest well................. . Distance from foundation-------------------.Distance to nearest lot line......_....._.... ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth-.--------------=--------------- Cesspool: D;stance fromnearest well------------------Distance from foundation....................Lining material---- -------------------------------- -------- ---..-...__,..._.-.--.-.._...... Size: Diameter_ ------ �JDepth------------------------------------ --------------Liquid Capacity----------------------------gals:` F ❑ w 9 I f �-- Privy;', Distance from, nearest well..............------- 1 ; ..---�__----._Dis#ante from nearest buildin Distance to nearest lot-line---------- Remodeling and/or repairing (describe)__________________________ __ ... -•------------ --•-•--------•-•-------- ----------------------- I ---------•------------------------- -----------...--------------------------------- - ------------------•-••-------..----- ---- . = # 6 =- -----•--------•-------------------------•-•-------- ---------------- ---------------- I herebycertify that I have 1 p p re ared this application and that the work will be done in accordance with.5an Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. oe I ----------------------------- ---------(Owner and/or Contractor) (Signed).... /� t TE+le (Plot plan, showing.size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). `t. FOR; DEPARTMENT USE ONLY i , APPLICATION ACCEPTED BY...i------------------------- - -------- �+ DATE--------------`.._-- •7 j DATE------------------------------------------------------------ REVIEWED BY I BlJ I LDING PERMIT ISSUED i --------------------------------------- DATE Alterations and/or recommendations•------------- - --•t 11 -------------------------------------------•------------- 9 I .. .-- --......__..-...-.--__._....._.__........ ......_.._. •--------------- ------------•--------. ---------•---- ------------- .........................................................c......--.....-------}--......-...-.-......-_-......__......__....._......-......_.._..... -.--•...-....•....................................... i------------------------..---------------......----------------------..............------------------------------.----------------------------------------------------------- --------------------------------------------------------- FINAL INSPECTION -BY:------ --- ----- F----- - Date-------------------- -- I SAN JOAQ.UIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak SYroe et 132 Sycamore Street 814 North "C" Street kt Manteca, California Tracy, California Stockton, California Lodi, California ES-4-2M : Revised W-2100 I I