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APPLICATION FOR SANITATION PERMIT Permit No. ____. /_ .. (Complete in Duplicate) Date Issued .-- P/ Applida*ion is hereby made to the San Joaquin Local Health District frarjo permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 54 . ----- -------------------------------•-------------------------- -----------------•---- JOB ADDRESS AND LOCATION_____�� ------- -- �- ----------- y Phone �� ----- ---�/ Owners Name-------- � '! -1 Address _ - ---------" - Contractor's Name__.------- Phone__.., - 1-------------------------- -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-___ Number of bedrooms 5tZ Number of baths _/___ Lot size/11>�Ixl 1 d----•---------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .-------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob� Hardpan ❑ Previous Application Made: ,Yes,E] No New•Construction: Yes No E]No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic Tank- Distance from nearest well_________________Distance from foundation-------------------__.Material------------------------------------------------- 01 . No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity---------------------- sposal Rtld: Distance from nearest well--------------___Distance from foundation---------------------Distance to nearest lot line___________._-_ Number of lines---- --------x: ------------Length of each line------------------------------Width of trench--------------i_ _------------------- Type of filter material-------------------------Depth of filter material.-_.-__________________Total length________---_-_-________ __ ------------- Seepage Pi :. Distance to nearest well-. Distance f m foundation_____ _________Durance to nearest ,_ e_--__ S J Number of pits---- ---------------Lining material - - - ---- --Size: __Depth-_ ---------, ---- -- esspool: Distance from nearest well_______________:Distance from foundation,- -._______`____.Lining materia l__________________ ______ �_ _._ ---Liquid' ap ty- . . --------------------•gals. :....,.--y,- ❑�. „�-:.� Size:,Diameter---`�":-W=-:,"'.r�:__-Der��----------------=--------------------------- acs t Privy: } Distance from nearest well_----- ------.-----------------------------------Distance from nearest building-------------------------- ❑ Distance to nearest-lot line----- --------�4- ------------------ -----1-�- .�-----------------------------------------Ae------- ` - �..-. ` _ 'G Remodeling and/or r pairing-jeelescr'ibe) �- ----------- - - - --------------------------------------------------------7--- -------------- --------------------------------------------------------------------------------7--------- -------------•----------------------- • - ......-...-.-----------._....------------------------•---'------------------------- I reby certify that I have prepared this application and that the work will be done in accordance with San-Joaquin County ordi nces, St e'I s,tand'ruI s and regulations of the San Joaquin Local Health District. / ti Z_ _ Owner and/oror Contractor( --- �(Sig v I ' F --------(Title) _ By:.............. ------------- -----------•------------ —� - -------------- - --J i (Plot plan, showing sizelof lot, location of system in.relation to wells, buildings, etc., can be P3aced on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- DATE - -- --------------------------------------- ----7 REVIEWED BY----- ------- 4_9 ---------------------- ------------ ---------- -------------------- DATE1 z:,� IIL BUILDINGPERMIT ISSUED.......... . .- --- - ---------------------------- ------------------------------------- DATE------------------ - ---------= Alterations and/or recommendations:--------------------________ ------------------•------------------------------------------------------------------------ ------•------------•--------- L 'Date------------- FINAL INSPECTION BY:------------ ----------------•------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; - Revised W-2100