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£_i f APPLICATION FOR SANITATION PERMIT Permit No. -- - --- .� '�~�'` }f "�•s'"� `�''n l °� (Complete in Duplicate) ` 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 No. 549, JOB ADDRESS AND LOCATION-------- Owner's Name--- -: -/-------- �- •------------•------------•- +� -----� s -------------------- Phone-- o , Address l� Contractor's Name -------------• ---- -� �"" -------------------------------------------- Phone_____4 : Installation will serve: Residence 7 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - -_--_ Number of.bedrooms _Z- Number of baths --- --- Lot size "' -J�0--- '�' �-D-' Water Supply: Public system -------------------- ; ,A Community system ❑ Private ❑ Depth to Water Table _ vff. Character of.soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ .e ,, 6 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eeptic.,T "`' d Distance from �„^s nearest well-'!---------------Distance from foundation----.- p al Fi ld r ---- MaterialNo. of,compartments- 1 -------------------------------- --- --- --------- -----Size------------------- - - - ---Liquid depth--------------------------Capacity------ - ------ Distance_from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line------------- t Number o: lines--------------------- ------Length of each line------- [ Type of filter material----------'- - --- -------Width of french------------------------- -------- 4 { - ---.---Depth of,filter material-----------------------Total length---------------•--------------------- --- Seepage Pit: Distance to nearest well-_ --Disfance rom tion- ------- Distance nearest lot line__-- � f Number of pits. 'Lining mat AA Diameter-- { " ---- Depth---��"�*�'"~-- Cesspool: Distance from nearest well-11--------------- Distance from foundation-__-__- Lining material-_------------- ❑ Size: Diamefer----`----------------- Depth --------- ---------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well-------------------------------------- ---_. Distance from nearest bu0clin - "W ' g----------------------------------------- Distance to nearest lot line--Ii' ------------------------------------ ------- Remodeling. and/or repairing (describ,.e)------------- ----- --------------------•---------••-•------•-•----- ------=----------------------•------- -------- -- -----•----•---------------------•---------------•-------------------------------------------•-------•------•---------•--------------------------------------- ! hereby certif fh I have ---------------------- Prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ! s, nd rules an 'regulation's of the San Joaquin Local Health District. (Signed)----------------- ! - --------•( her do or Contractor) # i' - ---- -- ------ --------------------------- If -------------- ---------- == Title. R [ ) = . = (Plot plan, showing size of lot, location of system,in rel n o wells, building a#c.; can be plated on reverse side). ;.FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---------------- ---= --------------- ------------------------------------------- DATE REVIEWEDBY - DATE ---------------------------- BUlLDWG PERMIT ISSUED r --•---------------------------- --------------------------------••------- ---------------------------------- DATE--------- �------------------------- --- Alterations and/or recommendations--------------------------------------------- ---------- --------------------------- ----------- ---------------------- --- ------------------- --- JJ FINAL INSPECTION BY------------- -----.----- " -------- Date------ �S'. - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Arnerican Street 1300 West Oak Street 132 5ycamore Street Stockton, California Lodi, California Manteca, California $14 North "C" Street Tracy, California ES-9-2M 10-52 Revised W-2100