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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issu Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h r n described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION... ----------------- `---------------------------------- Owner's Name--------------------------------------- 'e A 1 -------- _- - ------------------------------------- Phone-`7="0-/-7-/ .3------------- Address -- -.---------------------------------r---•----------------------•------------•-------------------------------------------•-------------------- ------------------------------ ! i ... .cam------------------- ----------------------------------------- Phone----2=f 0------------- Contractor s Name--- ----------•---•-----••--••------ (�.,�JC.c7�- �---- Installation will serve: Residence [M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - Number of living units: ---I--- Number of bedrooms - -. Number of baths I---- Lot size ---/--A--- ----------------- Water Supply: Public system Fel.- Community system ❑ Private ❑ Depth to Water Table .'Ap._ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Z Hardpan ❑ Previous Application Made: Yes ❑ Nor New Construction: Yes [:] E]No ,4 -y .�- ---'�y-�- TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se is Tank: Distance from nearest well-----------------Distance from foundation--------------_---.Material______-.-----._.__--_-.--.----__._.-------- _. ` '� No. of compartments---------------------- ---Size--------------------------------Liquid depth-------------------------Capacity--------- ------------- Disposal Fi Id: Distance from nearest well------- ---------Distance from foundation--------------------Distance to nearest lot line._..-_----..----- �'1 Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material .-.------_-_---__-----Total length---------------- --------------------- f � _. __.________- Seepage Pit: Distance to nearest well__J��O_�-.�_____Distance from foundation_--___s�___._____.Distance to nearest lot line._ d_. Number of pits.._---------------Lining material_ -- _.-Size: Diameter__,-7.?_'__ -------.Depth---a_ -- __-._____._.__ 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 and/or repairing (describe):------------------------------------------------------------------------•-•---------- --------- --••-------------------•---- •----•---•----------------------------------------------------------•- -------------------------------•--------••----------------------------- V 1 ---------------------•-•--------------------•------------------------------------------------------------- --------------------••---------------------------------------- ------------ ---------------------- ------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------- 3 I hereby certify that I,-h ve prepared this lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rues and TE lati n. of the San Joaquin Local Health District. r (Signed) Q.r' s1: ` 1 -- --------- [� * Co ntractorl �1. By:-------------------------------------------------------------------- - ------ r (Title) l�-f L .t LL� (Plot plan, showing size of lot, location of system in relation to, ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE1_-I--- --J) h 6 ate- l � -__. REVIEWED BY--------------------------------------------- ------ ----------------------------- --------------------------------- DATE--------- -------------------------------------------- ii ----- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:---.------------------------------ ------------------•---------•------------••----------------------------------------------------- -------------------------- ---------- ------- ------------------------------------- -----•---------------------- -------------------------------------------------------------------------------•------------------------------------- V hl=1NAL INSPECTION BY------------------ -- a��j�-- ------ ----•-- -- •Date----------�- -- - -- ------- -------- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 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 10-52 Revised W-2100