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! APPLICATION FORcSANITATIOIV -PERMIT + Permit No. _lt------- _._... (Complete in Duplicate) �•/j. y . `� Date IssuedA? 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. �y�r.._ .�° �� JOB ADDRESS AND LOCATION--------- - --- - - - ----- -�------- -------------------------------- ---------• - Owner's Name = = - - -------- --- - ------------------ ---- ------ Phone-------------------- ..__ , �L.�__ _ . - - --- - _ . ._.._ Contractor's Name a __ Phone Installation will serve: Residence [�}palrtment House ❑ Commercial ❑ Trailers Court ❑ Motel ❑ Other ❑ Number of living units:41 Numbtr of bedrooms Number of baths .L___ Lot size _____ ___________________ Water Supply: 'Ptiblic.'system [Community system ❑ Private ❑ Depth"#o Wafer Table y4- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ,Sandy Loam-H Clay Lpam ❑ Clay ❑ Adobe 91--'H-ardpan ❑ Previous Application Made: Yes 0 No [pNlw Construction: Yes �o ❑ a TYPE OF INSTALLATION AND SPECIFICATIONS: �.` (No septic tank or cesspool permitted if public sewer is available within-200 feet.) Septic Tank: Distance fromnearesr wellADistance from f�ound'a�ion___,P Q_ Mat ,I-- ______ _________'____-_ ______.___._. No. of compartmenFs _._ ) ... _ Size_J��__ YO > --Liquid depth -�-.: -----Capacity---' QQ Disposal Field: Distance from nearest `vrelll�?��:__tDistance from foundation_____/��a_�_._.Distance to nearest lot line-_____.�---- [� Number of lines-_____: ----------------- -- -Length of eafch line_ __ _ -! - ---_._.Width oftrench--_--�V--"�------------------ O� Type of filter materiaLS■ :. , ___Depth of filter materia/ylp_ _.� _ _._.___._.__Total. length------7________________________________ Seepag Pit: Distance to nearest.weii,-o---_----- - und Distance from foat:ion____________________Distance to nearest lot line---------- -- . Number of pits. _.'_�:_(___-__-_Lining materi�a+l__ _ _t_ _ fie: Diameter___ ' ..___.Depth____. __________________ well -_ fance from fouddation ______�_._-__._:' Lining ma#erial_________________________'__________. Cesspool: Distance from.nearest ❑ { p "`"-""""-� i ¢-__ _=__Liquid Capacity Size: Diameter---- - De th_ --------- -------gals. Privy: Distance from nearest well________________________________________________Distance from nearest building__________________________.________._ ❑ Distance°ton rest lot line~, - �•,_ ,.-------------------- --`-: '-------------------------------------------- "- Remodeling and/or repairing,.(d escribe):_._.?_---------- ----------_---------------- ----------------------------------- i - -------------------------------------------------------------------- ------------------------------- ------------------------------------------------------------------------------------------------------------------ --------------------•------------------------------------------------ I,hereby certify that I have.prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules end regulations of the San Joaquin Local Health District. ner and/or Cont 9 (Signed) --- ------, ---- ��- { Tractor) B : == = {Title) Y [Plot plan, showing sue of lot, loiati of system in relation to wells, buildings,'etc., can be placed on reverse side). . , FOR DEPARTMENT USE ONLY { k APPLICATION ACCEPTED BY... _ - __ _ DATE-----� - ' --t - -------- --------------- BY---------- -- "------------- _ ----- -- .. DATE ------------------- BUILDINGPERMIT ISSUED---------------------------------- --------=--- ------------------------------------------------------ DATE---= .................................................. Alterations and/or'.recommendations:-r____________________. _ -- -------------------------------•-----------------:--:----..---_ ------------ - --------- -------------------------------------------------------------.:----------------------------------------------------------------------- ------------------------------------------------------..._,.-_..-----------------------------------•-------------------=--•-- ------•------------------------ ------ ---- ------------ --------------------------•-------•----------------- ---------------------------------------- ------------------------------------------------------------------------------....------------------------------ .-- I r .�. -. ! � � � r � a 3 F`-- -5/ FINAL INSPECTION-BY:------'--- ` ----'------------ _._------------=_------ Da_to. 'a.- '--- - --------- --------------- -- -- - - - -- ----------- ti SAN JOAQUIN LOCAL HEALTH DISTRICT' 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "CF Street .Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M : Revised W-2100