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� S APPLICATION FOR SANITATION PERMIT Permit NcPf---- __ ------- (Complete in Duplicate) /s.2- Date Issued � r a ermit to construct and install the work herein described. Application is hereby made to the San Joaquin Local Health District fo p y This application is made in compliance with County rdinance No. 549. JOB ADDRESS A D LO ATI 1 --------------------------------------• ---------------------------------- ---- -- ---- -- - ---------------------- ---------- Owner's Name ------ ------------------------ Phone-------------------------------- - Address------''- -•------ �-------------- ------------------------ s w ----- ----- ---- - Contractor,'s Name_ = - `-��'v --------------------- hone ------ ----- ---- --- ---------------------— l Xer will serve: Residence Apartment House ❑ Commercial ❑ Tra} r Courtl3$K oS�aS❑ Number of living units: ---I--- Number of bedrooms __ Number baths �_�Lot size t Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sd Gravel F] Sandy Loam Clay Loam Ll Clay ❑ Ado PPP be �ardpan Elrevious Application Made: Yes F1 No No New Construction: Yes [g' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if publics wer is available within 200 feet. r " f_ Septic and: Distance from nearest well_ ___ Distap c �rom four ipn___�---_ --- ---- Capacity Mat1erI No. of compartments_________Z----____r SizeL-_#/__'_ _x-Liquid rrd��epth________-'t__�_______ --.--- -- - Dispo I Field: Distance from nearest wel _ __.-.Distance from foundation___ _Sf.........Distance to nearest lot le�i� i Length of each line-------- --0--0_ Width of trench______—----�t�_____________ Number of lines---- ------ .- g gy----- Type or filter mat er _ 1Depth of filter material____�__5---------Total length-------X-0Q______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation_-.-_______-______--Distance to nearest lot line---------------- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter ------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_.--'--------------Lining material---------------------------_--------- . ❑ Size: Diameter-- ----------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals! Privy: Distance from nearest well------------------- ----------------------------Distance from nearest building------------------------------------- ❑ Distance to nearest lot line---------------------------------------------------------- - --------------------------------------------------------------- --- - Remodeling an4/or repairing (describe):___ ------------------------------------------------------- =• --•--------- ----------------------• ------------------- --- --- - -- - ----- --- -------••------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co ` ' ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Owner and/or Contractor) i (Signed)------��cr�---- Tale (Plot 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-- - ---- -------------------- ------- ---- ------------------------------------------------------------------ - - - --------------- BUILDIN65ERMIT ISSUED_--_________ ________ _ DATE__________ -------------------------------------------------------------------------- ------------ ---- - - Alteratioiis and/or recommendations---------- -------------------------------------------------------------------------- ------------------------'�-------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- - _______________________________________ F. _ ______________________________________ ----------------------------------------------_--------------------------------------___________________________________________________________ Y _________._-------___._________.__-----_____--______________-_--__________-_______ __________________ _ f /_� f/ 4� '° . e, --- Date----- --- �A ---------------------------------- - FINAL INSPECTION BY:- ------- ----------- -- ------------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT , 130 South American Street 300 West Oak S+reef 132 Sycamore Street 814 North "CrStreet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 5-51 Revised W-2100