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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 for permit to construct and install the work herein described. r This application is made in compliance with County Ordinance No. 549. 1 .{' x- �_ ----------------------------------------------- Owner's - - --------------------- ` JOB ADDRESS AND -- -------------------------------- - ��----- - - �----'��-`-U--�=-�------------------ - - - Owner's Name------ i�"_">-;` -- -------------------------------- - -------------.-- ------ Phone------------------------------------ " Address---------- •" _ " ^f1-. '`---- ---------- - --------------------------------------------------- ---- - -� - --- -------------------------------- Phone---�a_-- Contractor's Name_________ _ ___- ----- -- ` installation will serve: Residence ��Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: __�___ umber of bedrooms __>�__ Number of baths _1____ Lot size ----_6e_/�6e)(1-2-d--------------------------- Water Supply: Public system [Community system ElPrivate E] Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel.❑ Sandy Loam E] Clay Loam El Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No W!r New Construction: Yes e No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if � �Ts. public Se �r is available within 200 feet.) SepticTa�kncea:from nearest well_ _/----.� istance from foundation-------------------- _______-Material----------------------___________________________ No_ of compartments-------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance;irom .nearest well______________.-Distance from foundation.-------------------.Distance to nearest lot line----------____:_. ❑ Number 'of lines-----------------------------------Length of each line-----------------------------Width of trench----------------------------------- Type of filter material_____________________ ___Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: -Distance to nearest'well-A64 _ D•istance om foun Distanceation__/�-f_.___. tnearest lot line-__ SII �. Number of pits________Lining materialSize: Diameter__ _ ____________Depth_.__ ___--------------- ; Cesspool: Distance::from nearest well--------------_Distance from foundation-------------------.Lining material-------------------------------------- ElSize: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------- gals. . kk Privy: Distance from nearest well_________________________________________ _Distance from nearest building____________________-______________-_____. I: ❑ 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 les anh d regulations of the San Joaquin Local Health District. i (Signed Kti�41L��& /�— -------------------_______________________________(Owner and/or Contractor) Plot lan, showin size of to ------- --------------------------- ------------------------- ------- R ( p g t, location of system in relation to wells, buildings, etc., can be placOn rev a side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED iBy- W__ ---- / ---: - - ---- --------------------------------------- DATE__,_! -: y.�J� --------------------- jl - GGT! r REVIEWED BY---------- ----------------------- ---------- ---------=----- ------------- ------- --------------- ------------ --- - DATE------------- ---_------------------ BUILDINGPERMIT ISSUED9----------------------------------------------------------------------------------------------------- DATE------------------------------- ----------------------------- Alterations and/or recommendations-------------- -------------------------------------------------------------- --------------------------------------------------- ----- ----------------------------------------------------------------------------------- 11. - ------------------------------------------------------------------------- I -------------------='------------------------------------------------------------------------------------- -----=-- ------------------------------------------------------__----------------- r -----------------------------------------------•- ----------------------------------------------------------------------------=------------------------------------------------------------------------------ ---------------------------------------------- ------------------------------- ---------- ------------ FINAL INSPECTION BY:-----------`4--- -------==------------- Date--------L,------1 '----------------------------------------- 1I SAN JOAQUIN LOCAL HEALTH DISTRICT �I 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