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�- ,q APPLICATION FOR SANITATION PERMIT Permit No. .Id,. (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and'install the described. Thi�,p cation 1s made in compliance iwith County rdinance No. 549- JOB DA{{D�PDRESS[AeNNDD LOCATION it4 � Owner's Name------------- 01111 ---------------- • ----------------------- ------------------------------------- Phone--- �}-�----��(�:-7--t-- Address Contractor's Name---------- ------------------ ---- -------•---•-•---------------------•------ •-----------�=z��""-- -------------------- ____ - -- ------------------------- ------------ ------------------.. Phone Installation will serve: Residence E!T"Apartment House F1 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms 2..-_ Number of baths -1_ -- Lot size -------- Water ___--7Water Supply: Public system fi2—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�iardpan ❑ Previous Application Made: Yes ❑ No Ej-'_New Construction: Yes LT�o ❑ FHA/VA: Yes ❑ No gg_- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if ublic sewer is,available within 200 feet.} Septic TaDk: Distance from nearest well-- -ZfE kL--"Distance from foundafion_1 _ No. of cornt arments-- p -fes---- ----------size---�X--r--4`-]+----------Liquid depth------ (-- --------- Capacity Disposal field: Distance from nearest wellQh , Distance from foundation_j-4------------Distance to nearest lot line--;!S71 Number of lines--------Y _ "" --- Length of each line: _" 1 ��---- -------- Width of trench-----�-`-1----------- ---------- Type of filter material------tQ44- Depth of filter material___----I_$-----------Total "".___""-_ Seepage Pit: Distance to nearest well-_-------------------Distance from foundation------------._____.Distance toWnearest lot line__.,_:___-----___ ❑ Number ofpits --------- Dept ------Lining material---- ------------ -size: Diameter-- --------- ------. h------- ------ Cesspool: Distance from nearest well-----------------Distance from foundation------------------_Lining material____'___-__ ------------------- El Size: Diameter ------..Depth--------------------- --- -----------Liquid Capacity-`--------------------- - -- --- �--- - - --gals. Privy: Distance from nearest well___-1-----------------------------___._--.__---_Distance from nearest building El Distance to nearest lot line-------____--__.___ Remodeling and/or repairing describe):----_--.-"- "_ - ------------------------------------ ------ •--------------------- ----------------------------------- --------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------•---------------------------------------------------------------------__:---------------------------------------- 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 rulesre ulations of the San Joaquin Local Health District. i (Signed) T `-------------- --------------------:----,(Owner and/or Contractor) By:--------- ----`---------•------------ - ------ ----- ---------- ------------------ - ------(Title)------- -•---------- ----------- -- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY e APPLICATION ACCEPTED BY_---. . _"& ------- --- --------- --r _ DATE ._` REVIEWED BY------------------------------ ------------------------------------ ------- DATE --------------------- BLJILDING PERMIT ISSUED --------------- ------- = ------------------------------------------- DATE Alterations and/or recommendations:______.- "___.__- _ -----------"""-""" --------- ---------------------------------- -----•----------------------•---------------•---------- - - -------- ik-- Lor• -_wear � ° '- - - __ �/'.',------------ ------------------------------------------------ FINAL INSPECTION BY:---------"--- Date-_---.�. - --•---------------------------- ------- ---------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street "i32 Sycamore Street 814 Nor+h "C" Street d Stockton, California Lodi, California Manteca, California Tracy, California_ ES-9-2M Revisea 1.57 F-P,CO.