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r V APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) - Date Issued "Z-' Application is hereby made to the San Joaquin Loca4 Health District for a permit to construct a d install the work herein described. This application is made in compliance with County Ordinance No. 549. } � - �_ f ----------- JOB ADDRESS AN .00ATION--- -- -------------- - - --_-- - ----- -- .--_ I - zu,+ _- �- - Phone - { Owners Name--- - - -----------y AddressC--- ---------y--- - - ------ P ------------------------------------------+---------------------- Contractors Name-----------•---------4+&-!rte-- -E---+�---�� ---'f'--- -�i-°G"-V �`'-------------------------- Phone----Fns;�4!P,7---.--. Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____r Number of bedrooms .`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 14 Hardpan ❑ Previous Application Made: Yes ❑ No 6--New Construction: Yes ❑ No ❑ 42 o TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) \ ptic T,a�k: Distance from nearest well-----------------Distance from foundation--------------------Material_________-___-____________________-------_----� o No. of compartments---------- ---Size-•----------------------------Liquid depth-.------------------------Capacity----------------------- " �- Disposal Fie{dc Distance from nearest welL4 ___Distance from foundation__��_____Distance to nearest lot ine---57 Number of lines _I_- -------Length of each line---__ ------------- Type �_iWidth of trench__ . ��________________ Type of filter materia -___ _______Depth of filter material-----1-f--,---------Total length-----_/ _fl'___________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation---_----------------Distance to nearest lot line-_-___________-_. ❑ Number of pits----------------------Lining material--------_--------------Size: Diameter------------------------Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation__________________Lining material------------------------------..___. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------- Privy: Distance from nearest well___-_-_-______________________________________-Distance from nearest buiHing__-__.--.--------_-____-___________-_____. t Distance to nearest lot Ii e---------------------------------------------------------------•-•----------------------------------------------------------------- -------- Remodeling and/or repairing (describe): - ------- ------------------------- z - ----------------------------•---------------------•---- ----------------------------------------•--------------•------•------ -- ---- ------------------------••------------------------•------------•-•---------------------------------•-•------- - ------------------------------------------------------------.------ --------•--------------------------------•-------------------------•-•--------------------------------------- ---------------------------------------------------------- I hereby certify that I e prepared this ap rcation and that the work will be done in accordance with San Joaquin County ordinances, State laws, an 'r les and egulatio of the S Joaq in Local Health District. t - . ..------- ---- r Contractor ( -- - ----- ----•- - - - - -----`�'-- ----------- f Ate' By:----- ---- - -------- ---------------------------------- -----------------------------------------(Title) •- - - --- -- - -- ------------------------; (Plot plan, o g size of lot, lo i of system in relation to wells, buildings, etc., can be aced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____ _______________ _ __-_______._ DATE-__!/_________ .- REVIEWED BY --=---- ------ __ DATE � - BUILDING PERMIT ISSUED-------- - ----------------------------- ----------------------------------- DATE-----------0j1 - Alterations and/or recommendations---------------------- -- --------------------------------------------------------------------=------------------ -------------- -0----------------------------------------- ------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------•------------------- --------------------------------------------------------------- -------------------------- FINAL INSPECTION BY: (_A/ Date---------- --S^ Z"_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton,•California Lodi, California Manfoca, California Tracy, California ES-9-2M 8-51 Revised W-2100