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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) J 5�3 4 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 County Ordinance 49. esL JOB ADDRESS AND LO ATION._:_- -- ---- __-- - -- - -------- -- d ----------ae---�__�-�_y_-?----------------- Owner's Name > �f � T- _ 1 Phone -•--- Address---------------------------_-------- = . Contractor's Name------- ------ AX0 i ..-. ---- 1 ------------------------------------------------------------- Phone-51P SPC/ ---- Installation will serve: Residence K Apartment House ❑_ Commercial ❑ Trailer Court E] Motel ❑/ Other ❑ Number of living units: __ Number of bedrooms __f_/____ Number of baths __I--- Lot size __CIl_ _ _?! . -----------------_______ i Water Supply: Public system i❑ Community system ❑ Private ❑ Depth to Water Table_f_ ft. eCharacter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ` Previous Application Made: Yes ❑ NoNew Construction: Yes E] No 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--------------------------------------------------- t, ❑ No—of compartments----It------------ --------Size------------.-: ------------Liquid depth----- ------------ --------Capacity----------------------- Disposal Field: Distance from nearest well----------i__..:.Distance from fou ndation______-__'_._._._Distance to nearest lot line----------------- Nu'-mber ________________Number of lines-----.------`----------------'-----Length of each line------------------------I......Width of trench----------------------------------- lk Type of filter material_;____ ________________Depth of filter material-__________._--_�---_Total length___.____.________.______-____-__---_-.__ � I " e i Seepage Pit: � Distance.to nearest well_.�p1y!�_____Distanc�from foundation-__J�_______.Distance to nearest lot line--/ Number of pits__67 _(�_ Lining material_____�(.i_��{„___-Size: Diameter__.3�.__r�/A�__De fin_ S p --------------------- Cesspool: Distance from nearest"well______-__!""_Distance from foundation-------------------.Lining material------------------------------------- El Size: Diameter ---------------------------E -Depth----;--------------=--------- ---------------------Liquid Capacity-.--------------------------gals. Privy: Distance from nee est well -__._.--__:`---------------------------------- Distance from -nearest building---------------------------------- ❑ Distance to nearest lot line _ ------_----------------------------` f Remodeling and/or repairing (describe) F _:____-- :-------------------------------- ------------------------------------------------------------------- =- _ _ ----------------------------------------- --------•----------------- I hereby certif a have prepared this application and that the work will-be done in accordance with Sats Joaquin County ordinances, Stat aws an rules and reg lations of the San Joaquin Local Health District. (Signed}_.. s ---- - -------- - --- ----- ---- - ------ - -----(Owner and/or Contractor) �. By:------------------------------------ -- -- --•------------------ ------ ------ -- -- ------- t -----------(Title)---- J------• t ------ ------ ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placLd on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE-----.. BY ---- - - -----------------------------------------------------•--- DATE_r,�__ -' _.'...�_---- BUILDING PERMIT ISSUED-------------- ------------------------- -- ------------------------------------------------------------------------------ DATE--------------------------------- ---------------------•----- Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------.-_-•----- -------------------•------------------- -----•--------------------------------------------------------------------------------------------------------------------------------- ----------•----- --------------------------••-------------•-•-------------------•--- -----------------------------------•-------------------------------- -------------------- ------ ---------- - ------------ ------- -------------------------------------------- ----- ---- ----- -- -- ------ ---- -------------------------•-------------------•-- - —--- -- ---- -- ------------------ FINAL INSPECTION BY------------- - Date....... _______--- _ 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 10-52 Revised W-2100