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i APPLICATION FOR SANITATION PERMIT Permit No_ _____ _______ (Complete in Duplicate) o+ Date Issued ------ ------ - - Application is hereby made to the San Joaquin Local Health Dist ict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance: 549. a -------- ADDRESS AND CATION___________ f --- �----- JOB -� Owner's Name - ------------------------------------------- Phone ---- -2--- Address. ' - •---- ----- -------------------------------------'----.----------------------- __ . q Phorie=.7_.. Contra ctor's Name----- —,� � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ U" / ate - -- ---------------------------------------- . -�_____ Number of bedrooms _ _ Number of baths ._l___ Lot size . ----------- Private -_-. ___ . _ Number of living units: ---- Water Supply. Public system Community system ❑ Private ❑ Depth to Water Table ; ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Loam El Clay Loam ❑ Clay El Adobe Hardpan E] Previous Application Made: Yes E] NONew Construction: Yes No El 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--------------------------------------------------- i No. of compartments---------------------- Size-----------------------L---------Liquid depth--------------- - --------Capacity----------------------- Disposal Fiel : Distance from nearest well_________________Distance from foundation. Distance to nearest lot line______'_.__.____. ' dumber of lines-----------------------------• ----Length of each line-----------------------------Width of french.----------------------------- e. - P --- Total length ------- yP "_____-__De Depth of filter material___-__� �-( Distance to nearest lot iine__�__�_� T e or filter ma#anal.__.____""_.___ - Seepage Pit: Distance to nearest well_. - -----Distance from fou dation___ ___"_-__ p � - _ . Number of pits--_J--�--------------Lining material__-,----- ze: Diameter-'==------ .ff_De tn--.--------------- i �� r Cesspool: Disfance.from nearest weil_________________Distance from foundation----"____-_.______.Lining materia4__._"___"__________"______.__.___"__. Liquid Capacity gals. 1N ❑ Size: Diameter-------------------------------------Depth---------------------------------------=-------- q P y------------------ \,n I s "__"Distance from nearest-buildin Privy: Disfance.frdm nearest well------------------ --: 9 _ -------- ---------- - S j +,.. µ ,o _ :.. _ ----------------------------------------------- -------" 0 ❑ Disfance to'nearest lot line______. "'_____-._-- -------- -------------------- Remodeling and/or re a:rin describe :_.-_-___-._ _ ' g r P 9 ) --- ------------------------------------------------ -------------------------------------------------------------------------------- ----------------- 'I t . i "� ------•-----•-------------------------••-----•----...--•----------------------------------------------------------------------------------- ---- '1 r --------------------------- -------- ------------ ----------------------------•-----•--:-----•----••------ --------------------•--------------------------------------- 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 ru)lps aid regulations-of the,San Joaquin Local Health District. 1 (Owner Contractor) -------�----------- (Signed) Aon Ow and p 'Con# or - �. 1 -;-- • Tit a ----- - ---------- f -------------------------------------------------------------------------------{ ) (Plot plan, showing size lot, location of system in relation to wells, buildings, etc., can be plaerse side' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY __ DATE _ REVIEWED BY---------- '------------%J111-- ---------------------------- ------------------------------------ DATE--' BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------------------------------------- DATE ------------------------------ Alterations and/or recommendations:------------------_--------------- ---" ------------•-----------• --------------------------- ----------------- } --------------------------•----------- ----------------------------------- --------------------"--------------------- ._.... -----•--- ------------------ ,: ---•----------------------------------------- � r y FINAL INSPECTION BY:--------- --- ------------------------------- Date----------------- --� -� --- ------ - _--:'/ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 5 camore Street 814 North "C" Street 134 South American Street 340 West Oak Street y Tracy, California Stockton, California Lodi, California Manteca, California y. ES-9-2M 10-52 Revised W-2100