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4- APPLICATION FOR SANITATION PERMIT Permit No _... (Complete in Duplicate) Date Issued ._.__►_�� 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 54 JOB ADDRESS AN D?f CATIO .. � __ ____ Owner's Nam 2t/f --------- -- --- -- t t �?"' = Phone_ �- -------- Address Contractor's Name_____________ = r ----------------------------------------------------------------- Phon � Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ ther ❑ Number of living units: Q_ Number of bedrooms 45�7 Number of baths.re_ Lot size a� _vim __________________________ Water Supply: Public systemA Community system ❑ Private ❑ Depth to Water Tabl(�._oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob� Hardpan ❑ Previous Application Made: Yes E] NoFNew Construction: Yes `, No ❑ `1 •TYPE OF INSTALLATION AND SPEC I ICATIONS: // (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se 'c Tank: Distance from nearest well_________________Distance from foundation-------------------Material_______-______.__._____..__-_-..__-___.__-___-. No. of compartments-------------------------Size--------------------------------Liquid depth--------------------- --- Capacity--------------- D' osal Fi Id: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line-_---_____._____ Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------------- -------------- Type -------------- _-__-------------- Type of filter material_________________________Depth of filter material-----------------------Total length----------------------------- h i Seepage Pi Distance to nearest weil__,A .Distance jo. #o hdation___ _�1....___.Ditante to nearest lot line ---------- Number of pits.__.__-__.______Lining material_ _ _ _ :f .Size: iameter_ 1960-9.r----__Depth---- --------------- Cesspool: Distance from nearest weft-----------------Distance from foundation__..__.._-_.__..Lining material__-___________._____.____---_________ ❑ Size: Diameter----------------- -----------Depth--------------------------------------------- -----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____--.--__._.__________.___.___.__._. ❑ Distance to nearest lot line-------- --- ---------- -------------------------------------------------------- Remodeling and/or repairing (describe)----------- ----- -- ---- ----°--------•----------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- -----------•--------------------------------------------------------------------------•--------------------------------------------------------------------------- ------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, ules a ations Qe San Joaquin Local Health District. (Signed)---------------------- ---------- - ----- - ----- - -------- - -,----------------•---- --Zdn (Owner r Contractor) - - By: (Titl - — ---------- (Plot plan, showing size f I , location of system in relation to wells, buildings, etc., can bd5i everse si e): FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------------------ - DATE.----------- - REVIEWEDBY---------------------------------------------------------------------------------- ----- --- ------------------------- DATE-------------- -------- ---------- ------- BUILDING PERMIT ISSUED-------------------------------------------------------------------- --------------------------------- DATE. Alterations and/or recommendations:-------------------------- ------------------------------------------•-------------------------------•-----•---------------------•---•------------------------ --------------------------------------------------•--------------------- ------------- ------------------------••---------------------------------------------------------------•---------------_---------------------------- -------------------•----- ------- -------------------------------------------------------------------------. -•------------------------------•----•-------------------•-•--------------------------••------------ --------------------- ------------------------- --------------- -----------------------------------------------•----------------------------•-------------------------------------------•---------------------- f FINAL INSPECTION BY------------- '----- ---------j----------------- Date------------------------�J` / r 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