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APPLICATION FOR SANITATION PERMIT` Permit No. ____ _ _____________ (Complete in Duplicate) Date Ensued -----!--------•---hM 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 OrdinaZ ce No. 549, JOB ADDRESS AND ATION-- -- .----;f ---(�.% --------------------•------------------------------ --- - =' = f---------------�-�----- aOwner s Name------ Phone Address-_ - - ---- ----------------- ----------------------------------------------------------- - - ----------- ---•---�--..•---••--•-•-------- Contractor s Name Phone---- Installation f- - will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-____ Number of bedrooms _ Number of baths _ ___ Lot size _ fir._-��-.-.._ -- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tablt_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob_a�rHarclpan ❑ Previous Application Made: Yes ❑ NoE]New Construction: Yew No TYPE OF INSTALLATION AND SPEC F1 ICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S:Dptic Tank- Distance from nearest well_________________Distance from foundation-------------------.Material------------------------------------------------- r❑ No. of compartments--------------------------Size--------------------------------Liquid depth.-------------- ----------Capacity------------------ --- isposa iqv: Distance from nearest we€I_________________Distance from foundation--------------------Distance to nearest lot line______________... �❑ .,t Number of lines-----------------------------------Length of each line-----------------------------.Width of french---------------------------------•- i Type of filter material---------------------____Depth of filter material-----------------------Total length------------------------------------------ Seepage ------_._____._ -------------------------- Seep ge Prt: Distance to nearest wel ��_"f'_"..-_______Distance f m fouAation_ A�!__._ Distanp to nearest lot line----V Number of pits---- --------------Lining material__ Size: Diameter_________________Depth____: __+ , Cesspool: Distance from nearest well-----------------Distance from foundation------------____----Lining material-----.-_----_-------------___________- ❑ Size: Diameter------------------ ----------- -------Depth----------------------------- ------- ------Liquid Capacity----------------------------gals. J Privy: Distance from nearest well-------------------------------------------------Distance fry m nearest building.___________-__________________.____._- ❑ Distance to nearest lot line--�------------------I------------------------- ••------- `'` ---------------- --- - l Z Remodeling an /or repairing (describe): _ __ _ __,�__ _t.._ __. .__ _ '_ __ . t _ ______ " � -----•--------------------------- -------------- r-------------------------- •-- = = - --------- ----------------- ------ ---------------------------`------- y -••-----------• ------ -.- a = ---------------------- ------------------------------------------------ I hereby certify that 1-have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State-.laws, and rule and'regulations of the San Joaquin Local Health District. (Signed} F ` --------- {Owner and/or Contractor} Lam:__ - -- x / 1 . BY:------------•--------------------�.: --.._:.�`�?��s------------------------------------------------------------------------------{Title}---�-�%--6-�------;_'�-�'----- ----- •------------ (Plot - ----- �* (Plot plan, showing size of to+, location of system in relation to wells, buildings, etc., can be placed ora/`verse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------- _-- DATE------ -----DATE------------- �� REVIEWEDBY----------------------------------------------------- --------------------------------------------------------------------- - ----------------------------------- BUILDING PERMIT ISSUED------------------------------------------�t------------------------------------------------------- DATE------------------------------------------------------.. Alterations and/o recommendations: - •----------------------------- •-------------------- ---------- --------------------- --- '- �- -. I ��------------ == ------------------------------ - ---- ------------- --- -- -------.------------------------------ FINAL INSPECTION BY:--- .-___-- Date...------I---r------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Straet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9---2M Revised W-2100