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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District ffo9r a permit to construct and install the work herein described. This application is made in compliance with County Or e No. ' JOB ADDRESS AND LOCATION--., --VO4-,;e�..... . - 'sr'r` ,�,/ --_.---- Phone---------------- ----•----------- Owner's Name /? fes ---- ------- =------------- ------------------------------------- -------- � --- .----- r-, .-- ----------------- ------------------ / o Address___.. .__ qqrr - ---------------- ------- Pho __________ ____ Contractor's Name----��-�"------- -----�-- --��--- -------- ------- --- ------- ------------ l Trailer Court ❑ Motel ❑ Other [IInstallation will serve: Residence )e Apartment House El Commercial ❑ Number of living units: --/--.. Number of bedrooms _-%I- Number of baths ___/__ Lot size Water Supply: Public system ❑ Community system 0 Private X Depth to Water Table -------- ft. { Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe x Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction- Yes ❑ No 9 O 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_"------------ -Distance from foundation------------------ Material------------------------------------------------- F1No. of compartments--------------------------Size------------------------------- Liquid depth Capacity Disposal Field: Distance from nearest well �----Distance from foundation______�rL '.Distance to nearest lot line_- G.____..- .Width of trench---------- _.____.__ Number of lines-_____--__--- ��"""""-_----Length of each line___._- "------ -- �� - - ------Total length-------��•"�--------------------- Type of filter material_"�_t----f&--Depth of filter material____------ Seepage Pit'. Distance to nearest well---------------------- from foundation___.-"..............Distance to nearest lot line----------------- F1 Number of pits------------------"_--Lining material------------------------Size: Diameter------------------------De pt h _ ❑ --------------------------------- cesspool: -------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation.._.____.--__-_""_.Lining material------------------------------------- ---------------------------- gals. Size: Diameter---------------------- ---------------Depth--------------------- ------------------------- Liquid Capacity Privy: Distance from nearest well--------------------------------------------------------------------"-_"-_Distance from nearest building-----------------------.------------------ _ __ ------------------- ----------- Remodeling ----------------------- --------- - ❑ Distance to nearest lot line---------------------- ------------------------------------------------------- emodelin and or repairing (d scribe):----{' -�-- ---- - -------- - ---- -------•--- R g ----7s - --- ----------•_ �---------------------------•------------------ �fi --- ---' ---------------- - j - - == �� tibe--- ------------ ---------------------------------------------------- ------- > I hereby certify that I have repared this application and that the work done in accordance with San Joaquin County - ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i -• -` --- - - - M /or Contractor) (Signed)----�-+- -- -------- - ...a.c.O�i. - ---------------(Title)-------------------------------------------- BY:-- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______________r- --- DATE---------------------------- -------------------- ------ r DATE-_ ----- -- REVIEWED BY - DATE---------------- ------------------------------------------- BUILDING ----------------------- BUILDING PERMIT ISSUED. --------- ---- ---- -- ---------- Alterations and/or recommendations:---------------------------- --------------------------------------------------------L------- ---------------------------L-----------I------------------------- ------------------------------------------------------------------------------------------- --------------------------------------------- ----------------- -- � /f 'A--- Date.. ---- -�-- <�------------- - --------- - ---------------------- FINAL INSPECTION BY:-______"-A/-- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Trac California Stockton, California Lodi, California Manteca, California y, ES-9-2M 8-51 Revised W-2100