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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) r///,,// Date Issued ____-!.T/S�_-- 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 No. 549, JOB ADDRESS AND 'LOCATION__--_ ` Owner's Name•------•---- '7 ------ � _Z1� =--------------------------------------- - ----------------------------------- Phon Address.............. - - = ------------ = r elk/ 1 t Contractor's Name ' - #-------- --- ---------- -- ----`J =--------------- Phone --- -Y&Q T � . Installation will serve: Residence E] Apartment House ❑ Commercial" ❑ Trailer Court ❑ Motel Other ❑ iNumber of living units:-_# Number of bedrooms______._ Number of baths --------- Lot size --- 10-12-`_X__Z-Q.1—-_-______________ Water'Supply: Public system ❑"Community system ❑" Private Depth to Water Table 40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe( Hardpan ❑'l' Previous Application Made: Yes ❑ No g New Construction: Yes ❑ No rVi TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Disance from near Septic ctik q0� Not of compartments- -----------------------twell-- -- ----- DisSiztance from fou`datiLiquid depth---------Material__--- Capacity----------------------- Disposal _._._______._______Disposal Field:,/C_ Distance from nearest well----___-----------_Distance from foundation______-:-- - ------- to nearest lot line----------------- ------Width of trench---------------------------------- I .❑ r tNumber of lines:_____-----------------------------Length of each line------------------------ Type of filter material--------------------- Depth of filter material------------------____-Total length------:..-____.____________ ! Seepage Pit: Distance to nearest well__ ��__-�,___�istance from.fo 'dation____.-ss_____- is a ce to nearest lot lin J__.ZQ------ Number of.-pits___..1'J�_-_._Lining materiaI__:� Size.: Diameter___ -----------Depth__ --------------------- \ Cesspool: Distance from ne&.est well-----------------Distance from foundation--------------------Lining material-_---________.______ ----------- El �. .. , Size: Diameter---- F---------- --De th-------•---------- ----------------------------- ---------------------- Privy:. or.--t-gals. Li uid Ca acitY- ------------------- -- Privy: Distance from nearest well ___---.---------- -------------------------Distance from nearest building------_-__._______________-___f________- Distance --------------------------------- \\, to nearest:lot line -=---- --------------- ----------------------------------=---- ------ --------------- = Vj Remodeling and/or repairing (describe):_____ _______ _ ___ __°s t__________._ __ ------------------------ A ---- - ----- --- -- - ---------- •----------------------------------- --------------------------------------------•-.----- r. I hereby certify that,l have pre d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,'iand'rules/ nd r ulations of the n Joaquin Local Health District..' 5 (Signed)---------------------------------=----- -------------- -- --- -------- --- - ------------------ -. ------ i (Owner a /or Contractor) ., ' BY� = - --- ---- --- --•-------- -- -----------(.�L` --- ---- -- -- ---- - -- (Title)--•---J - --- - • . . ------- (Plot plan, showing size of lot, location`of system in relation to wel s, buildings, etc., can be plat 'on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -------------------•------------------------------------------------------------- DATE - l REVIEWED BY--------------------- --- - ------ ----- DATE-- BUILDING PERMIT ISSUED:_- DATE = - Alterations and/or recommendations:____________________________ =� ` ---•-••.............•---------------------•---------------- --' ---- f- e -fi ----------=----------------------------------- ------------------------ ------------ ••------------------------------ --------------------------------------------------------- ....... ---------•---------------------------------- ------------------------------------ ----------------- --- ---------- FINAL INSPECTION-BY..- " = --------------------= Date------- --X : 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