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APPLICATION FOF SANITATION PERMIT Permit No. ----------- (Complete in Duplicate) Ik/ Application is her.eby made' Date Issued _�6 '�I to the San Joaquin Local Health District for a permit to construct and install the work herein cle crib � This..applicafion is made in compliance with s c Con Ordinance No. 549. JOB,�ADDRESS A LOCAT N__ ..... . . ... --------- ...... `Name ----- Phone-_10-1 m Address----__---- -- ----------- -------------------------------------------------------------- ----- --- -------- ------------- ------------------- ---- Contractor's Name-------------•------------------------------------------------------------------------------------------------------------- ------------------ Phone Installation will serve: Residence E— Apartment House E] Commercial 0 �Tr'ail_er_ Court [-] Motel El, Other= Number of living units: -1--- Number of bedrooms -.I-- Number of baths __/---- Lot size Water Supply: Public system El Community system C] Private 52--bepth to Water Table%9-,0- ft. Character,of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loa.m Loam El Clay E] Adobe ❑ Hardpan ❑ Previous Application Made: Yes E] No 5R--' New Construction. Yes [e- N' El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T well__-_ --- irom foundation----/P---------Material--- Distance Septic Tank: Distance from nearest w I---- --------------- No. of compartments----------9------------ ----------Liquid depth---------�W------------Capacify-,F-"')�-------- Disposal Field: Distance from.nearest well--------1�#�------Distance from foundation___-A-6-------Distance to nearest lot line___ Number of lines------ ---- --------Length of each A i -_q------:Wiclth of trench------ rench-----X-Vff------------ /Y Type of filter materiaL-101--f-j- Depth 81 filter'maferial -.--Total length- 40------------I------------- Seepage Pit: Distance to-nearest well-----------------------Distance from"foun.clation--------------------Distance to nearest lot line---- El Number of pits----------------------Lining material----------------�k--Size: Diameter------------------------Depth----------------- ------------- ---- ----------- Cesspool: Distance from nearest well------------------Distance from foundafion---------:---------- Lining material____---___.___________._:_____.____' 104�S� .Size:-.Diameter-==------------- :Depth-------------- - -------------------------------Liquid Capacity. -------------- Privy: Distance from nearest well___________________________ Distance from nearest - --------- building___________________• ------ - Distance to nearest lot line Remodeling and/or repairing (describe);----------------------------------------------- ------------- -------------I --------------I----------------I--------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------•--------------•-------------•--------• --------------------7--------------------------------------------------------------------------------I------------------------- ------------------------------------------- -------------- -----------------------------------------------------------------*---------------------------------------*--------------------------------------------------------------------------------------------------------- h hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulesand regulations of the San Joaquin Local Health District. (Signed)---------------------------•------------------ ----------=-------------------------- ----------------------•------------------------------------ _--- wn an ontrador) By:---------------------------------- --------------------------------------------------------------------------------------------------(Tif 10)------ ---- (Plot plan, showing size of lot, locafioA of system in relation to wells, buildings, etc., can be place reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8 ----------- ------ --- ------------------------------------------------------------ DATE------ REVIEWED BY------------- ------------ ------------- DATE------ - -------------------------------------------- ---------------------------------- ---- BUILDING PERMIT ISSUED ------------------------ --- ------------------ Id,---------- --- ----- ... ------------------ DATE--------------- - 4Z -i---------- - -- ------------------------ Alferafions and/or recommendations:---------------------- --- ------------------------------------------I----------------------------------- -------------------------�m--------------- ------------------------------------------------------- --------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- I--------------------------------------------------------------------------- ------------------------------------------------------------- ------------ --------------------------- -------------------- ---------------------------- ------- ---------- ------------- --------------------- ---------------- ----I------------------------------------ ------------------------------------- 1 FINAL INSPECTION BY: -7 Date----- - ---------- 7---------------------------------------- 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 B-51 Revised W-2100