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V APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) +� �� Date Issued __. ----- A p cation is hereby made 4 to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made 1n ccompliance with County Ordi ante No. 549. JOB ADDRESS AND L-OCATi N_.___�f_�t•3- ---__-_---_- - _-• $.. - -----------------•---------------------- -----•-------- • ---------- Owner's Name w - _ j/- ` --------------------- ------------- -----"- ----------------------------------.2_. Phone__ qq- ---�-- -------_-------------- Address------------- ---------------•---Address------------- -L ._gp- l_ -- Contractor s Name------ -------------------------------------------- Phone--- Installation will serve: ;Resi 8encel a--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living un i s: _!___ Number`of bedrooms --A- Number of baths __1__ Lot size Q-�__--1� l QA �_____________________ Water Supply: Public system Uy Communify system ❑ Private ❑ Depth to Water Table _YQ ft. Character of soil to a depth of 3 feet: Sand ❑ "Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan E]Previous Application Ma e:1 E] No New Construction: Yes E3 No TYPE OF INSTALLATION 'IAND SPECIFICATIONS: �- ,��^-dam (No septic tank or celsspool permitted if public sewer is available within 200 feef.) U Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material -_____._______.__. ❑ No. of 'Com.partments-------------- ------Size--------------••-_--------------Liquid depth----------------- ------Capacity----------------------'\ Disposal Field: Distance rom nearest well________________Distance from foundation--------------------Distance to nearest lot line______________--ft El Number or.lines-----------------------------------Length of each line------------------------------Width of french %.M Type of filter material-------------------------Depth of filter material------------------- length----------------------------------- ---_ Vt Seepa 'Pit: Distanceto nearest well-------—------------Distance _f______ -------- D's a--p earest lot line- to ._-Dumber of pits___-___/___.._-----Lning mate ria C __ ze: Diameter__._ { -------.Depth__.- 29 Cesspool: --_-_•-_.-_-Q-_---_--- Distance.from nearest well_________________Distance from foundation-.___._____._______.Lining material______-_______._-_____ ❑ Size:: D"ilppmeter------=-------------------------------Depth-------- 4-----------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------`_______________________-_ ---Distance-from nearest building g------------- --------------------------- ❑ Distance to nearest lot line-------------------------- - - --------------------- Remodeling and/or repairin? (deseribe}:_-_- ----- +-f,- -S„N --------- 0 `` .r.. .. " ---•-------------- -------- ' -------------------------------------------------------- -------------•----------------------•-----------••_------------••------------------------------•---------------•--------------------------------- I hereby certify that I hFave prepared this application and that the work will be done"in accordance with San Joaquin County ordinances, State laws d"rules and regulations of the San Joaquin Local Health District. (Signed .___.O-y�. 9 } - ----------------------------------------------(Owner and/or Contractor) BY: _ .--`-------------------------------------=---------------- --------------------------(Title)--- (Plot plan, showing size of Iof, location of system in relation to wells, buildings, etc., can be placed on reverse side). al: l _ FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED ABY-------------- ----------------------------------------- DATE - --------------- - ----- BY ----- - --------------------------------------- --------------------------------------._ DATE------- ---•- - -------------- r BUILDING PERMIT ISSUED_�N�_______________ ---------------------------- DATE---------------------- Alterations and/or recomme9dations:------- -------------------------------------------------------------------•------= = ----------------•----•---------------•911 ----- ------------------------ ------------------------- ------------•--•------------------•--P------------------------- -----------=•---- ------------------------------- ------------------------------------------------:---------•-----------•------•--------------------------------------•----- -- -- ---- ----------------------------------------------------------------------- - ---------------- i . . FINAL INSPECTION BY:.�-------------- Date-- --------------------------- .�3' SAN JOAQUIN LOCAL HEALTH DISTRICT i I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California I ES-9-2M 10-52 Revised W-2100 �-