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APPLICATION FOR SANITATION PERMIT. ,� Permit No. y_) r (Complete in Duplicate] " 5 >II Date Issued !�/�/�_0 Application is hereby made to the San Joaquin Local Health District for a pe. mf- it to constr and install the work,herein described.. This applicafion is made in compliance with County Ordinance No. 549. ------- W- -------- ------------------------------------------------------ JOB ADDRESS A OCATION__�_____ __�T_ r1�'' _ __.: Owner's Name---- - • --------- 1•-- ------- --------- Phone ----------- ---------------- ------- Address----------------------- — ' ___ -----------I- --- ---- -- -----�•-----------------•-------------------------- / Contractor's Name ` Phone �pf_ 37,&7--- Installation will serve: Residence RKApartmerif House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units.- /-_ Number of bedrooms --r__-- Number of baths __ Lot size ------_-----------------------------_ Water Supply: Public system Tr-c—ommunify system ❑ Private ❑ Depth to Water Table 50 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ,[Hardpan ❑ Previous Application Made: Yes'P90*'*No ❑ New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank .or`cesspool permitted if u6lic sewer is available within 200 fee+.) I Septic T c Distance from nearest well/!k' '/Distance from foundation-- -- --------- No. of compartments_._ Size .. ______Liquid dept`__< ,(_.T ____-Capacity__ / Dis osal F Distance from nearest welll?�__ Distance from foundati n _..-__.Distance to nearest lot line �___- P Length of each line__- __`____ __117 Width of trernch._,�_��__..q __ I. Number of lines- Type of filter materials- - epth of filter material___ _._________Total length_________________s ; Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__.._.____._____ [] Number of pits______________________Lining -Material-----------------------Size: Diameter------------------..___.Depth__.------- -----_____ Cesspool: Distance from nearest well------------------Distance from foundation---------------- -Lining material _-----------------------------_----- Size:'Diameter--------------------------------------De th----------------------------------------------------Liquid Capacity ---------- gals. Privy: Distance from nearest well-----------_-----------------------------_r_-__---Distance from nearest building-------------------_--______-_,_--_-- ❑ Distance to nearest loe - Remodeling and/or repairing (describe):__-___ - - -------------------------------------------------------------- ----- -- ----- ---------------- ---------------------------• --------------------------------------------------- --------- --------------------------------------------•----------••-------------------------------------------------------•-------•-------------------------------- ------- -------------------------------------------------------- -------------------------------------------- ----------------------------------------------------------- ereby ertify'th . I have prepared this application and that the work will 6e done in accordance with San Joaquin County dinances, S. s, and ules regulations of the San Joaquin Local Health District. V [Signe _. (O nes and/or Contractor) l --------------••---........ -------- Title By: _ a (Plot plan, showing size of lot, location of system in relation to welis, ildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY- -- ,---- --------------- DATE------ - sREVIEWED BY-----------------------------------7-------- --------------------------------- ------- -------------------------------------- DATE------------•----------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------ ------------------------------------ Alterations and/or recommendations-------- ---------------- ...------------------------•------------------------------------------------------------------------------------------------------- --------------------------•------------------------•---------'---------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------•------------------------••--------------------------------------------------------------- •-----------------------•--------------------------•-------•------------ --- Date ----------------- FINAL INSPECTION' 7 - L` 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 1.57 F.P.CO-