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Permit No. APPLICATION FOR SANITATION PERMIT _a I (Complete in Duplicate) Date Issued --- "l o a k ` 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 N91)54907 ---•--------------•----- AND L ATI ----- - - --- --- - --------- -------•-------------------------�-- ---------------------------=-------- JOB ADDRESS Owner's Name_________________ ------ ---- ---- Phone-11W Address---•••---------------- -------- --------- 1 -------------------------------- Address ----------- ----------- Phone,-- Name--------• •---- - - •-- - -- --- - - ----------- --------- � �. Mote Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ Number of living units: ___ Number of bedrooms .2;;�_ Number of baths __ " Lot size _e_ -------- Water Supply: Public system El Community system ❑ Privateth to Water Table �1_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ^ f Previous Application Made: Yes ❑ No L�f I'ew Construction: Yes E3No TYPE-OF INSTALLATION AND SPECIFICATIONS: 3 (No septic tank or cesspool permitted,if,public sewer.is available within 200 feet.) p}i k: Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- I ___________--__________-_________-_--______- No. of compartments-----------SCJ -----size--------------------------------Liquid depth.--------- ---- Capacity---------------------- i s Disposal Field: Distance from nearest well_____°___.__..._.Distance from foundation-____ " __.Distance to nearest lot ®/ NumbEr of lines__I-:-- --- --- Length of each line__ , ,*----------•----.Width of trench----- y"""------------------ Type of filter matenal_S-t_ p --Depth of filter matenal___.. ir M------Total length____- -------------- T Distance to nearest lot line_________________ Seepage Pit: �D�stancejo nearest well__.-_.:.-'' --Distance from founda#ion________________ ".❑ --------Depth------------------------- ------- _V Number of pits----�---------------Linin material.----------------------size: Diameter---------.--"-- - g .. -.,, Cesspool: Distance from nearest well-______-_______Distance-from foundation____________________Lining material_______..--"-- - als. (__1❑ Size: Diameter---- j-------------------------------Depth----� ----------------------------:----"Liquid Capacity----------------------------g It I ' I Distance from neareO building----------------------------------------- Privy: ,Distance from nearest well__-------------------------------------------------------------------- Distance #o nearest lot line---- ❑ ----•------- ---------------------------- -------- - -"""---------------------------------------------=----- f Remodeling and/or repairing (describe)___________________________-------------- ---- ----- k -------------------------- -----------------------------------------------------------•-•-----------------••-----------------"•----------•------ -; I hereby certify that I have prepared this application and'that the work will be done in accordance with San Joaquin County ordinances, laws, and rules and regulat' ns of the San'Joaquin Local Health District. '-- -- .....................-------- -------- r Contractor] _.[Ow� r and/o C tor) Si ned �1./! -------- ------------------------ - [ 9 )-__ • -------------- By:----------,/��-----------•- [Tit lel [Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY --- ----------- APPLICATION ACCEPTED BY-------• ---- -------------- ----------- ---------•---------------------------------•-•--------- DATE- ----� -- REVIEWED BY------------------------------ --� BUILDING PERMIT ISSUE ---------------. ------•---- •------"""-•- DATE--------------•------ - -__________________________________-___- --------------------------------------------•-----------------•-------- Alterations and/or recommendations: ----•---- -----------------•---------- ----"---------------•- -------------------- FINAL INSPECTION BY:------ ------------------------------ Date.... 5 --------------------•-------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300•West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California -- - .... ^-----j W o,nn -