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�-� APPLICATION FOR SANITATION PERMIT Permit No. 0-�°-�------- -' (Complete in Duplicate) ' i Date Issued _____________ 1 Applica{ion 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. w JOB ADDRESS AN OCATION____ - '-----� n -------------- Y Owner's Name. ----- ---------�-- - ------------------------------ ------ Phone._._------------------- Address----------_---- P----------- -- - - - ----------------.....---------------------------------....----------------------------•--•----••------------------------ Contractor's Name. -_ ---- - -- ---------- - Phone ... installation will serve: Residence 9�'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _9-___ Number of bedrooms A/--- Number of baths _ __ Lot size Zl,fWater Supply: Public system Community system [I Private [:] Depth to Water Table 7V__ . Character of soil to a depth of 3 feet: .Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 5�3' New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k Se ' a Tank: Distance from nearest well_________________Distance from foundation-_-______._.__. --Material_____________-_.____._-_-_______._-____-___-__. No. of compartments----------------------- --Size_----------------------- -•---Liquid depth-------------------- --Capacity---------------------- �jDispm I Field: Distance from nearest well________________Distance from foundation_____-_. ___._.Distance to nearest lot line._.__________-__- j' Number of lines------------•----------------------Length of each line-------------------------------Width of trench------.---------------------------- �! Type of filter material-------------------------Depth of filter material___- -------....__.Total length------------------------------------------ Seepage __-____.___.-_________-____________-___. I � See a e Pit: - Distance to nearest well_' -_-Distance from foun ation__ . P 9� ____.__-_.Dis nce to nearest lot1line___-_.__. Number of pits-------/__----------Lining material_C-_4______.___ Size: Diameter-•r' _...________Depth.___.G�-s� ------ Cesspool: Distance from nearest well-----------------Distance from foundation.-----__._..--------Lining material__.-_-_-_____________.__.__.____-____. Size: Diameter-------------------------------------- Deth-------------------_ -----Liquid Capacity----------------------------gals. I. Privy: Distance from nearest well-----------------------------_-------------------Distance from nearest building--__.-____.____________---__------------. i ❑ Distance to nearest lot line------------------------ Remodeling and/or repairing (describe)_____________________ f ---------------------------------------------------------------------- f ' 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 rules and regulations of the San Joaquin Local Health District. r�- ` � f (Signed)•-.---....-•-•------------------- ---- _ - -----(Owner and/or Contractor) Plot tan, showing size of lot, loc on of system in relation sy------------------------------------------ --------------[Title)- - -- - ( p g y n to wells, buildings, etc., can be place on reverse e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------- - ------------------------------------------------------------- DATE-- --- ---------------------------------------------- REVIEWEDBY------------------------ ------ -------------------- --- ------- ------ DATE------------- BUILDING PERMIT ISSUED------------- ----------- - DATE------- - - - - Alterations and/or recommendations:_- ----- •-----••-•--------•-------- -.----- i = s 1 .--"_ Y -------------------------------------------------------- ••------- --------- 9?, ------------------------------------------------------------------------------ -_ -------------------------------------- ---------------------------- --•-------------- ------------------------------------------------------------------------- ------------------------------------------- --- -------------------- ---•----- ------------------------------------ FINAL INSPECTION -BY:_,� ------------------------------------- Date.-_.-J._ ---L_ - - 1 - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California J Lodi, California Manteca, California Tracy, California E5--9 145446 ATWOOO