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k •.. - Permit APPLICATION FOR SANITATION PERMIT .` A fi P Vii, (Complete in Duplicate) f� 1 Date Issued/-,.-?- ------------ Application 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 Count Ordi�nl�t9. . JOB ADDRESS DG"ATION___�____ j _ �r -- - --------------------------------------------------- -- - �--•------------- Owner's Name--- - -------- ----- =-------- a-- --------------------------------------------- ---- Phone--�-----� - Address-------r� . � -- ---- - - -------------------------------------------------------------------- Contractor's Name ------- ------------------------------------------------- --------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote) ❑ Other'❑ Number of living units: __�___ Number of bedrooms _ - Number aths ___!__., Lot size ___ -O=____x_IL�_�________________________ Water Supply: Publics stem ❑ Community system '❑ Private Depth to Water Table __-----. ft. Y Y Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 20'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic ank: Distance from nearest well ►�} .____Dista111�ce from fours!�� on---/- _----_____.Mate�rriia_ _._____ ___________________ _----------- No. ___ __ No. of compartments____________ !_______Size_?-_- __Q-_x"y` iquid depth________ __ �Capacity____e�_ __�a I Dispos 'Field: Distance from nearest well__°"-_____ __Distance from foundation__I�a.„-----Distance to nearest lot ine----_��_______ Number of lines___________ _ � - -___ Length of each line________________ -------Width of trench ---- :______________________ �f } Type of filter material -.€�t� Depth of filter material-------- :_E--------Total length-----l ____________________________ l 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 9 ❑ material____________-_____--___-------_-_____. Size: Diameter------------------------------------De Dept --------------------------------------------------Li Liquid Capacity---------------------------gals. Privy'"' ,v �"'"�" `"D ist8h_Le__from'n_ rest well_'_____ - --- ---- _____ :Distance.-from.nearest building__ _____r ElDistance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/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, St �Iaws, an ules and regulations of the San Joaquin Local Health District. . ____Owner and/or Contractor k (Signed)----- ( / kkBy:--------------------------------------------------------------------------------------------------------------------- --------------(Title)---------------------------------------------------------------- 4 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can,be placed on reverse side). ( t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - --- ------------------------------------------------------------------------------- DATE_- REVIEWED BY------------------ ------------- _ .. ... ---- ---------------------------------------------------------- DATE--- , ------------------------------------------------------ - BUI ------- BUILDINGPERMIT ISSUED--------- ----- ----------------------------------------------------------------------- DATE----------- ---------------------------------------- Alterations and/or recommendations---------------- ----- ------------------------------•------------------------------------------------------------------------------------ k --------------------------------------------------------•-----------------------------------------------------------------------------------•-------------------------------------------------------------------------------- i -------------------------------------------------------------------------------------- -- -------------------------------------------------------------------•--------------------------------------------------- --------------------------------------- --9- I FINAL INSPECTION BY:------- -_- --- -- --- ---------------------- Date_ --_--- - E SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100 r'