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APPLICATION FOR SANITATION PERMIT Permit No. ... 7LL_"____-- (Complete in Duplicate) f� Date Issued Applicaa-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. 54 JOB ADDRESS A CATION_ __ v d ' -- i Owner's Name------ .._ . ------ Address .-- = Phone Address..-•--••-------------------- ------------------------------- - - ------------ -------------------------------------------------------------------------------- Contractor's Name `----•---•---•--•--- r Phone.lia_`_!- 4_ Installation will-serve:—Residence-D .I Apart,ment-House.•2---C-orrmme.rcia1-0 Trailer--P u t ❑ Motel ❑ Otherx, Number of living units: ______-_ Number of bedrooms __ Number of baths > ___ :Lotlsize ---- Oa__`_�P Q---------------------------- Water -_____________._____ Water Supply: Public system' Community system ❑ Private ❑ Depth to Water Table �D ft. Character of soil to ardepth of 3 feet: Sand E] Gravel E] Sandy Loam C] Clay Loam E] Clay ❑ Adobe ' Hardpan ❑ Previous Application Made - Yes ❑' NoNew Construction- Yes E] Nox TYPE OF INSTALLATION—AND--SPECIFIC-KA,-TIONS: ----�� 1 (No septic tank or cesspool permitted if public sewer is availableiwithin 200 feet.) Septic Tank: Distance from nearest well_��'�!___Distance from foundation___ __©_____,____.Mateal- _ _-___.___ _. N�. of compartments-______o�________________Size__$_X-3.4-----------Liquid depth------��_..S----------Capacity----L�'_�i Disposal Field: Distance from nearest well._Distance from foundation---,fd___ _----Distance to nearest lot line_-_S-._-_____. __ Number of lines_____ _________ ____ _________ _Length of each line______JQl____________-Width of trench___. .. ____ Type of filter material__Sr.6 Depth of filter imaterial____-Ame._,- Total length-_ 3O----------------------------- Seepage ____________________________ p g Distance to nearest well__ ____Distance fr }o ndation___A.....:___.Distance to nearest lot lin,____' _______ See a e Pi#: N mbar of pits k_____ _ Lining material____- T __:Size: Diameter----3-.�__ -------Depth__�_15__________________ k C` Cesspool: D.istan.ce fiom nearest well`'-__.___.____':,Distance from foundation._.__._________-_.Lining material____________________________________ "V Size: Diameter__'-----------t-----------------------Depth---------------i=-------------------- -----------Liquid Capacity gals. r t r Privy: Distance from nearest we ---------------.:-- ',{------------:-----Distance from nearest building-------------------------------=---------. ❑ Distance to nearest lot•line -A -------------- F - -----------------------------------------------------------`-'----------------------- ---s F • Remodeling{and/or repairing (describe):---------- - ---- ----- ------ -------------------------------------------- ---------- ----- --•--------••-•----- --------=- ------------------------------------------------ --------•----------- -•---------------•-----•----•-•-----•--•---------------------- --------------------------- -}-------------------------------------------'---------'------=------ --_---------------------------------------..--------------------------------------------- ---------------------'------ ------------------'----- ------- :------------- I"hereby certify That I have prepared this applicatiori,.and that the work will be done n accordance with San Joaquin County ordinances, Stat a s, and rules and regulations of the'San Joaquin Local Health Districf. ! ) ` - __-__Owner and/or Contractor .[Signed)... # ----------- ) By--- -------------------- ` ` -------------------------- -------(Title)------ - - -'------------------------------------------- c (Plot plan, showing si�e of lot, location of syste in relation to wells, buildings, et ., can be placed on reverse side). �= FOR DEPARTMENT USE ONLY --------------- i•APFLICATION ACCPTED-BY DATE------- ------------------------------------------------ REVIEWED ,SY '`s '-�':- -------------` '"° DATE BUILDING PERMIT ISSUED.............? ---- =- - �-- DATE-------- __-- Alterations and/or recommendations-------------------------- ------ --•-------------- `^_ ......... -----•---------------•--•• ------•----- ........ ........ ---•---------------- ---------- -----------------------•--•- ------- --- - --- 1 } # A ---------------------- -------- --•--=------------------------------------ ------------ -------•-------------------------------------------------------------•---- —-------------- --- 1. -- ------------ - -- - -- -- -- - --------•---- ----------------------------------------------------------------------------•-----------------------------•----------------=----------------------- -- - - - -- - - -- - - - - - - - - Date " a — FINAL INSPECTION BY:-------- -- -- --�------------- - ' ------------------- � �----------"�-�--- --------------------------------------...__... t 4 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 Revised W-2100