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_2- i APPLICATION FOR SANITATION PERMIT Permit No. _7_7_��_ 0, (Complete in Duplicate) Date Issued ApYlicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. f This application is made in compliance with County Ordinance No. 549?4� _ 1 JOB ADDRESS AND OCATION--------- - Owner's Namej��------ -------- ----------------------------------- ----- Phone------------------------------------ Address--------------------- --- Contractors Name--------- `'- - ---dd ------ --- / ------------- Phone - (P --- Installation will serve: Residence Apartment House Commercial ❑ ❑ p ❑ ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __A0_ Number of bedrooms --- Number ofeaths I---- Lot size ----- - ---------------------- Water SuPPIY Publics stem ❑ CommunitY system Private Dpth to Water Table . ft. Character of soil to a depth of 3 feet: Sand D.. Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay El Adobe Hardpan E] v Previous Application Made: Yes E] No New Construction: Yes Flo ❑ t( TYPE OF INSTALLATION AND SPECIFICATIONS: ��aaa (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Ta k: Distance from nearest well _ ----__Distance from foundation/d-----------Mater-ai__�_ -------- A- :_ -- r No. of compartments_____ ________________Size___ Liquid depth___, _--- _ -----Capacity___a Disposal Fi Distance from nearest well__ ---.Distance from foundation___ -1--____ ' .l ______Distance to nearest lot line____________ Number of lines__- -._ l____ __ Length of each Pne_-_. _�___ e---.Width of trench--_,, _____________________ b+C1l Typo of filter materia Depth of filter materia L_ _ Total length.. _Cr__._____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-----___-----_ i ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-_------------------_------------ Cesspool: Distance from nearest well----------------- from foundation--_----------- ---.Lining material---___--_-----_----_.--_----__-_----. ❑ Size: Diameter---------=----------------------------De th------------------------- Liquid Capacity---------------------- --gals. _ P. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______-_---___--_---____-__ -------------- ❑ Distance to nearest lot line--------------------------- ----- f Remodeling and/or repairing (describe)--------- ------ ---------------- f- ------------------------•-----------------------------•------•---------------------------------------------------•----------------------------------•---------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ 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. �3-- G (Signed)-------- - -- ------ ---- --- - - -------- ------------------------� (Ow r an or Contractor) BY:------------------- t ---------------- - (Title) C - -------------------- at plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ . _ DATE------------ ----------------------------------------------------------- ---------------------------------------------------------- REVIEWED BY DATE ---------------- _-- - ,� ----- - ----------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE - - -------------------- Alterations and/or recommendations: -•-------------------------------------------------------------- -------•--------------------------------------------------- !. ----------------------------------------------- ! ---------------------------------------------------------- ---------------------------------------------•----------------------------------------------------------------- ----------------------------------------- - ! FINAL INSPECTION BY______________ pg C -- G"..7 ------ --- ---�---------•--------- D --- Date-------------------- .��' - � r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Scree! 300 West Oak Street 132 Sycamore Street 814 North "C" Street � Stockton, California Lodi, California Manteca, California Tracy, California- . i ES-9-2M 9-51 Revised W-2100