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' r APPLICATION FOR SANITATION PERMIT Permit No. __✓�__ __.9____... (Complete in Duplicate) Date Issued _41 Application 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 Ordina e No. 549. JOB ADDRESS AND CATION--• --- 45747 t = --- - '�' --------------------------------------- --------- --------------- -- - �/ Name--- a r CE' rte" ------------------ Phone. ------------------ Owner'; � ---------------------------------------------------------------- Addres - t _ I i -- -- ------- --- Contractor s Name----- -•--- ` Phone.. 'r Installation will serve: Residence Apartment-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ ____ Number of bedrooms _-9„__ Number of baths _/_.. Lot size __--q�, ''. --____________________ Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table./ ft. Character of soil to a depth of 3 feet: ,Sand ❑ Gravel ❑ Sandy Loam ❑ . Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Nog ..New.Construction: Yes No ❑ ! \\ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if public sewer is available within 200 feet.) Septic Tk: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- % ( , X Noz. of compartments--------------------------size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal F'pa: Distance from nearest well-----------------Distance from foundation--------- ---------Distance to nearest lot line._._.-__.________ Number of dines-----------------------------------Length of each line---_-------------------------.Width of trench----------------------------------- Type of filter material--------------------------Depth of filter material-__-____._._----__-___Total length------------------------------------------ _:::..Distance to nearest lot .. Seep gel�if _ Distance to nearest well ,� _______Distance f m fo dation___/ _-_ ! Number. of pits---- _.--._Linin material - Size: Diameter_.-. .De th_____ * ------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.---____..___.______________------ ❑ Size: Diameter---------------- ....................Depth....•--.............................................Liquid Capacity----------------------------gals. Privy:r Distance from nearest well--------------------------------------------------Distance from nearest building--------------._----_-____________.____._- ❑ Distance-to nearest lot line- --------------=---- ---------- ----=----=----------- -------------- ------------------------- Remodel in d r repairing [describe):__ __._.___ ('7 ________ _ ---� _- --- ----��--- ----------- -------------------------------------- ------------------------ ------------------------ ----•-••---------------- ------------ --- ----- -------------- -------------------------------------------------------------------------------------------- 1. ---------------------------- ------------------------- ------------- ------------------ ------------------------------•------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will,be done in accordance with San Joaquin County ordinances, St aws,.a r es and regulations of the San Joaquin Local Health District. (Signed)----• � --- -- -----------------` ------- `------------------------------------------ -------(Owner C and/-or Contractor) By:•---------- ...:......" ------------------ --------------------•---------------------------=--- (Title]- --------- ------------ (Plot plan, showi g size of lot, location of system in relation to wells, buildings, etc., can be plc on rever side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-�-_ - DATE-- -----------------.-•-----•-----•------------------- REVIEWED BY------------------------------ . --- --- - ---- .----- ----- ---------- DATE-- : BUILDINGPERMIT ISSUED ----------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------------------- --------------------- ---------------------------------------------•-•-------_------------•---------------••------- ---------------------•----•------------------------------------------------------------------ ------ -------------------------------------------------------------------------------------------------•----------------------- ---------------------------------------------------------...----------•-----------------------------------------------•---------------------------------------------------------------------------------------------------- i ----------------- -------------------------------------------------------- ------- --------.-�--�-�•;-II-��-,-,,------;-,- - ------------------------- ----------------------- S5 FINAL INSPECTION -13Y:-------- Date--------------------------------------------------- --n---------•-------------- 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