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1� 533 APPLICATION FOR SANITATION PERMIT Permit No- -- ------------- (Complete in Duplicate) Date Issued --- f ApplicaTion is hereby made to the San 4Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County OrclinanR No. 544. ' t JOB'ADDRESS AND LOCATION °{ '., .^. (�1 � ` Owner's Name----- Phone--- ---------- Address ] � �Jr �- .1t .- -------�------ ---------------------------- ---- - --- 4 Address--- g -------------------•----------- ----'- - - ... ------------------------------------------------ -- Contractors Name---- - --- -------- ---------- ---: i--•----------------------- Phone---2 ---- d �, Installation will serve: ¢Residence El Apartment House F] Iercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------->Fnbar of bedrooms --.-____ Number of baths --.---._ Lot size ------------------ ----------____--____-.---_---.-_ b # F I # Water Supply: Public system Community i'yste ❑ Private ❑ Depth to W f r Table Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam ElClay,Loam E] Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Yes to ❑ TYPE�OF INSTALLATION AND SPECIFICATIONS: (No septic fank or cesspool permitted if public sewer is-available within 200 feet:) . . ar>tc: Distance from nearesr well -------------Distance from foundation----f---.-----.-_--.Material-----_______-----------..-..-__---.---__-----. #c No. of compartme�i ._:-E _ ------Size---------------------------- --•Liquid depth--------------------------Capacity.. -1 ispes Field: Distance from nearest we{I'- --------------Distance from foundation__-- ---I------.---.Distance'to nearest lot line----- __------- Number of lines--------------r-J -------.-----:Length of each line------------- ---q-----------Width of trench----------.-,---------------------- Type of filter material-_-----_,.'`-------------Depth of filter material------)__-r__--____.-_Total length--------------------------------.-_-__-.- Seepa Pit: Distance to nearest well-,c,0'± _-_----.__-Distance from foundation--r�$_.........Distance to nearest lot Number of pits------ --------- )r Lining material-_ --- Diameter--=--�-� ---Depth------ ••------------ Cesspool: Distance from nearest well ----------------Distance from foundation r---1_1 --------- Lining material------------------------_:---._----_ El Size: Diameter,------:'------------I ---------------Dept.h �.--�-�---------------- ----------Liquid Capacity gals. N If Privy: Distance from,neaFest well____-=- ' "`s"7----.--Distance from nearest building--------------------------------------- --- ❑ Disfiance`to nearest:Iot'I ne"+_:,.___.. - I Remodeling and/or repairing (describe)- -,--=--------------"� -----= = ==.."` _.-.._.. rw I) ► # L -=-------------•--------------------------•----- ---------•-------•----------------------------------- -----------------------------------------------------------•-----------------------------••-----------•--------------------•---------•--------------------------------------------- i� I hereby certify that I have re ared'f his'application and Aa+ +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules end regulations of the San Joaquin Local Health District. [5i ned —" 9 )---------------- ----•--•-•T--;;----- ------ -- ----••---.------------ ---------- ------ - -------------- -- ---(Owner and/or Contractor) , sy:.--••. � �... :------------------------- - [Title) ------------------------ (Plot a '"I (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- - _ DATE----------- /d-=L( REVIEWEDBY--------------- --------------------- -------------------------------------- -------=---------------------------- --------"DATE---------- BUILDING PERMIT ISSUED--------------- ------- DATE-----------__:------.- -- Alterations and/or recommendations---------------- - -------------------------•----------------------------------------------------------------------------------...-------------------------------------•-••-------------------------------------------------------••----- --------------------------•---•-- ------------------ ---------- ----------------------•------------------------------.------ ------ -----------•---•------------ - -------------___-_-_.-.--------.--...-.-..------------------------------- -------------------------------------------_---_-_-------------------------------------------------------_------------•--------------•-------- FINAL INSPECTION G BY----- -- ---- ---•------ -- ----- - --------------- ----- 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, CaliforniIa Tracy, California ES-9-2M Revised W-2100