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Q APPLICATION FOR SANITATION PERMIT Permit No. --/• - __-- `�- (Complete in Duplicate) Date issued \,9 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 Ordinance N 549. IIII JOB ADDRESS AND OCATION d ------E-------------- -------- ------ --- ------•--•-------•---------_----•------------------------------------------------- q7 ----- -------------- ------------------------ all 1 7 q Owner's Name___ ___________ Phone___ _../--/- ------ �/ ----------------- -- Address-----------� --- ---.-� -•--- ------ ------ ----------------------------- ---------------• ----------------------- -- ----------------------------------------------- Contractor's Name--------- -- -- ---- ------ ----- ------------------------------ ------••-------------------- ------------- Phone d�-- it Installation will serve: Residence.Apartment House [3 Commercial E] Trailer Court ❑ Mptel ❑ Other ❑ Number of living units: -__ Number of bedrooms .J-_:Number of baths --- 'Lot sizeQ---------------------------------- 41Water Supply: Public system [9`1 Community system EIPrivate E] Deptto Water Table _ __ ft. Character of soil to a depth of 31et: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Lo m ❑ Clay ❑ Adobe 0/""Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes JCI No [ , TYPE OF INSTALLATION ANDSPECIFICATIONS- (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) dp Septic Tank: Distance from nearest well----------------- from foundation___________________.Material------___________..__________-_.___.._-_...____.� ❑ No. of.compartments-----------------------Size--------------------------------Liquid depth =' - Capacity Disposal Field: Distance from nearest well_________________Distance from foundation___________-----__.Distance to nearest lot_ line__________---...- r .1 ❑ s. Number of lines------- ------Length of each line----------------------------.Width of trench.------------------------- 0 Type of filfer�material-------------------------Depth of filter material------------------- Total length__._ --------------.-------------•---�-- y See Pit: Distance to, kearest well___. �.._____Distance fro fou dation______l ----:--.Distance to nearest lot line j_f ___ __Lining material- ----- -Size: Diameter ___.____.Depth_-_ Number of ptts--------f-----=- - � �i Za�----------------- " Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia ___._____-__-______________.___._. Sizer Diameter-------------------------- -----------Depth------------------------------------------------------Liquild Capacity-.---------------------------gals.�[ `____:.__- Distance frnm nearest building _______________________ r'O Privy: Distance from nearest well____________________ _ - 9 • . ❑. Distance to nearest lot line------------------ --------------=----------- - ----------------- - ----------------- -•---------•------------------ ----------------=------ Remodeling and/or.repairing (dlescrsb�e):----------------------------------------------------------------- • ---------------------------•--.. tI� ! ---------------•-•- -----------------------. •--------------------------------- -•---------- ----------------------------------------- ------- ------------------------------- . ,�� _+ ., dM l f i ----------------------------------------------------- i ... € 1-hereby certify that I have.1prepared this application and that the work will be 'done in accordance with San Joaquin County ordinances, State laws, and rules andlregulati ns of the San Joaquin Local Health District. 1 F �_'_ _.. f Owner and/or Contractor) (Signed)--=--- � -------- ----------- ------ ---------------------- BY� = ......-- ----- • - = ------...(Title)... . f (Plot plan, showing'size of lot, lo�ation of,system in relation to wells, buildings, etc., can be placed,on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-0----------------------------- ----------------- DATE------ ----- •--•---------------- DATE---------------- ------- REVIEWED BY- --------------------------N----------------------------------- ---------------------- ----------------------- --- ---- -- -----------...-- ----- BUILDINGPERMIT ISSUED.........P-------------------•--------------------= --t----------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:.-------•------.:_ _"---------------- ------------------------------=•--•----------------------•-------•--..-.--------------------------------•------------- 4li. "} ----------------------------------------- ------------------------------------------------------ ---------------=-------------------- �l� -� - ---- ------------------•--_------------- -----------------=------------------•--------------- - III ---------------Al ---------------- --------------------- -.------------ -- - --------------------------------------------------------------------------------------------------------------------------- t �'f7 i'� - FINAL INSPECTION BY: i - - ----- Date K-v' I - ) SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California i ES-9-2M I0-52 Revised W-2100