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�tiA 411 ,►a' APPLICATION FOR, SANITATION PERMIT (Complete in Duplicate) \ Permit No. /� Date Issued ___.__!Ij_ Applical-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. JOB ADDRESS ANDOCATION___ ----------------------------------- - Owner's Name------ - •-------- t :. Phone-� z, j Address--------- 2_4R,-7 -------# ! - -------------------------------------------------------- ...--------------- Contractor's Name ��-�r----------------------------•----------------------------------------------- Phone_,,_ I- t Installation will server Residence 7� Apartment House ❑ 'Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: a'=-__ Number of bedrooms Number of baths -__°z Lot size ___t --- 40..._ X _ --___-_____________________ Water Supply: Public system [l?--tommfunity system ❑' Private ❑ Depth`to Water Table Character of soil to a depth of 3 feet: Sand E]"Gravel`❑""Sandy Loam ❑ ._Clay Loam ❑ Clay ❑ Adobe 17- Hardpan ❑ Previous Application Made: Yes I] No R- New Construction: Yes ❑ No [B� TYPE OF INSTALLATION AND SPECIFICATIONS: "- (No septic tank or cesspool permitted if public sewer' is available"within 200 fee}.) r Septic Tank- Distance from? nearest well D t f f d t M ! ------------------------------•---------------------------------------------------------------------------------------------------------•--------------------------------• --------...--------------------------------- ---------------------------------------------••----------------------------------------------------------------------------------------------------------------------------- ------------------------------------ 1 hereby certify that l have prepared this application and that the work will be.done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ - ------------------------------------------------------------------------- -- ----(Owner and/or Contractor) BY= ------------------------------------------ (Piot plan, showing size of lot, location of syem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ F DATE_— --------------------------------- REVIEWEDBY -------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED_________________ _.________ DATE_____-_-_ Alterations and/or recommendations----------- ----------------------- -------------------------------------------------------------••---•-----•-•---------------- ..._.. -----•-------------------------------------------------------------------- .------- ------------------------------------------- ---------• --- -- 1 C. -q- ----------- ..r - FINAL INSPECTION BY:--- - - -s-------------------------------- Date-- ------y--Z-----`_'---- 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 -9-2M : Revised W-2100 ----------------- is ante rom oun a ion --------- ••--------- ateria No. of -compartments------------- """ -- Size` ---•-•-- ---------------------Liquid depth_........................ Capacity Disposal field: �. Distance from nearest well ..... !---------- Distance from'foundation --------------- --- .Distance to nearest lot line ____________..._. Number of lin-es ------- --------------------------- Length -.of each line -------- •---------------------- Width of trench----------------------------------- Type of filter, material_____.-_-._--�_`-_,l�epth'Of°filter material -------- ___ __'____Total length ____-___.______.__._.______-_-__.-_______- Seepage Pit: Distance to nearest well _-_____Distance rom foundation_._./2..d________--Distance to nearest lot line-�Q_.____ � Number of pits --_1 ------------- Lining material_ _��:.--- Size: Diameter___s�J__9__/-_______- Depth -------------------------- _ �_------------------ Cesspool: I Distance from, nearest well ----------------- Distance from foundation................._.Lining material --------------------------- __-________ ❑ � - �,:-----.Depth---------------------- - -----------------------� q------------------------------ Size: Diameter --__-_---L— .______ Li uid Capacity ---------- • --------------gals. Privy: � Distance from nearest well_____________ _______._ --_______.____-_-_.-___Distance from_ nearest building_____. -_____________-_______.__---___-_. ❑ Distance to nearest lot line_________________________ f Remodeling and/or repairing (describe): ------------------------------------------------ -_-----------------_--- ------...-----------------•------------------------------.-- ------------------------------•---------------------------------------------------------------------------------------------------------•--------------------------------• --------...--------------------------------- ---------------------------------------------••----------------------------------------------------------------------------------------------------------------------------- ------------------------------------ 1 hereby certify that l have prepared this application and that the work will be.done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ - ------------------------------------------------------------------------- -- ----(Owner and/or Contractor) BY= ------------------------------------------ (Piot plan, showing size of lot, location of syem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ F DATE_— --------------------------------- REVIEWEDBY -------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED_________________ _.________ DATE_____-_-_ Alterations and/or recommendations----------- ----------------------- -------------------------------------------------------------••---•-----•-•---------------- ..._.. -----•-------------------------------------------------------------------- .------- ------------------------------------------- ---------• --- -- 1 C. -q- ----------- ..r - FINAL INSPECTION BY:--- - - -s-------------------------------- Date-- ------y--Z-----`_'---- 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 -9-2M : Revised W-2100