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APPLICATION FOR SANITATION PERMIT ermit No. (Complete,in Duplicate) Date issued --- 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-,v } JOB ADDRESS AND LOCATION______ _ ---------------- -- ------------------------------------'- ------------- Owner's Name A -•--- -•-----=-----•-•-----------------••-•-•--------- ------- -------------------------- Phone------------------------------------ Address----------------- -----------------------------------Address--------------------------------- - ----•------•••----•-------------------- ------------------------- -•-------------•-•-----•------------- ----------------------------------------------------- Contractor's Name-( + PhoneA' = '= Installation will serve: ResidenceE]—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -± -"_"_ Number of bedrooms =. Number of baths --___ Lot size ---±xa_"_._ ----A•- ------------------ I_ Water Supply: Publics stem A.7' ft. y: y [�}-• Community system ❑ Private ❑ Depth to Water Table _�.___ ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q_-Hardpan ❑ Previous Application Made: Yes ❑ No E6,New Construction: Yes ❑ No Eg,`_,_ , I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �q Septic Tank: Distance from nearest well Distance from foundation----ZA_iMaterial.... L- No. of compartments_.-._ ,�.- ________- Size__ ,: / -0_-Liquid depth____- ! Capacity__ � - _--____ r Disposal Field: Distance from nearest well.,5j_j--....Distance from foundation__Z.b-------Distance to nearest lot line."__LY____ . Number or lines-------- ------------------------Length of each line----61A_-------------Width of trench_-_-_tA----------------------N Type of filter materiaj_`2- Depth of filter material....li-_.f`_.-_Total length____r' a--------------------------------- i f Seepage Pit: Distance to nearest well,- ------Distance ,rom foundation---� l____ Distance to nearest lot line__- ____-- b -r"'- Number of pits------ -------------Lining material. _,�o-_-V ,--.Size: Diameter_- '_-__...-__Depth--- Aj. Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material__--__.____________=.--------- ❑ Size. Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------galsj, ; Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------•------------------ - ❑ Distance to nearest lot line----------------- ----------- -------------------------------------- --------------------------------•----------------•----------------------- Remodeling and/or repairing (describe)----------I---------- ------------------------------•-----•-•-------------------•--------------•---------------•- --------------------••-•--• ------------------- `^ ----------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------- ------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ` ordinances, Statelaws, and rules.and regulations of the San Joaquin Local Health District. dc - {Signed}---- --- ----- ------------------=--=-------------------------------------------------------------------------------------- ------(Owner ar�d/,orwContractor) r�° ""' *•,•..------- ---------------- BY�--------:--:___-=----•=----=--- ----------------------------------------------(Title)------------------------------------------- -------- (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---- "---------fit - ---------- --------------------------------------- DATE------r-� 1 REVIEWED BY -- -- -�z� - - --------------- ------------- -- ---- .. DATE ` ` BUILDING PERMIT ISSUED ' DATE -- ----------- •-------------------- ----------------- Alterations and or recommendations ---_--___ _ / --------------------------••----------------------------------------------------- ------ + /��______________ ___.___-___-___---___ Y _______ ................. _________ _ ______ 7 __-______--_______---__ .__ ____________ _____ _____________________________________________________________ ___________---------------_----------------------------------------- I FINAL INSPECTION BY J- Date f---------- ----------------------------------------- SAN v `SAN JOAQUIN LOCAL HEALTH DISTRICT 4 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M 145446 A7WOU0 72-54 '�