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V t APPLICATION FOR SANITATION PERMIT Permit No. - (Co mpBt Daplicate), Date Issued 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 No. 549. JOB ADDRESS AND LOCATION.......... -. ' : Owner's Name-------- ----- ----•- - -- -------------7---- Phone------------------------------------ Address-----------------••--•-•------------------------ Contractor's Name------------------- --- ------------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: _/.----- Number of bedrooms Number of baths /___.___ Lot size _____ 4 -------------------- Water ---Water Supply: Public system 9 Comm pity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �IFrdpan ❑ Previous Application Made: Yes ' ❑ New Construction: Yes l-90 11 TYPE OF INSTALLATION AND SPECIFICATIONS: within S ptic Tank: Distance tank Distancecesspool nnea elft well- public sewer,istance froml� o nda iof} feet.)-----.- Material______.____-____________________"__----------_-- i��S d No. of compartments----------------- -------Size-----------_------_-----i----...Liquid depth-------------_- - '�„"' �/ q - --------.Capacity-------------------f Disposal Field: Distance from nearest well____.U� E!Distance from foundation__ Distance to nearest lot line_________..... ] Number of lines_____ __ ___ _____ ____ _ Length of each line____ I I Width of trench._-_r2_ .- , Type of filter materia_ --1 __.._ _ Depth of filter material......_._ .�"�__._Total length-- __ _--" -- X. ------------------ Seeps`e Pit: Distance to newest well_-_ _. - Distance om,foundation_-_ _ ]istagie to nearest lot line_--S____.___-. Number of pits-------- -----------Lining material C1G�<-__Size: Diameter---��-----------.Depth-_----�ioy�' C sspool: Distance from nearest well-----------------Distance from foundation___.______________.Lining material-------------------------------------- El Size. Diameter--------------------------------------Depth--------------------- ----- -Z- -----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------- .._----------Distance from nearest building----------------------------------------- ElDistance to nearest lot line-------------------------------------------------------- - = -------- -- Remodeling and/or repairing (describe)------------------------------------------------------------ ----------------------------------------------------- A-,--------- ---- I ---------------- ------------••------------•---------------------------•------• ----------- - f v-=-------------- ---------------------•---•-----------------------•-------•- -------------------------------- __....... --------------------------------------------•--------------------- ------------------------------------ -------- pre! P PP ----------- I hereby certify that I have reared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health bistrict. f ..» , t -------------------- By: -------- ------ (Signed)-----------•------ ---�•--•----•------ -------- - ------- � € � -,------;; .� � � j- -t-�(Qner and/or Contractor) Br• ------ -------------------------- -(rifle) (Piot plan, showing size of lot, location system in relation to wells, buildings, etc.;can be placed on reverse side). FOR DEPARTMENT USE ONLY ? APPLICATION ACCEPTED BY. --------------------------` --------------- DATE / ; REVIEWEDB ---------- ------------------------------------------------------------------------------- DATE ------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:------- ------------------------------ -----------------------•---------------•----------------•----•---------••----------•---- -•-----•---------------------------------------------------•---------------------------------------- -•-------------------•------------•----•------------------------------------------------------------•••-•-------------- -----------------------------I---------------------------------- ---- ----------------------------•-------------------------------------------------------------------------------------•---------• ---------------•-------- ----------•-•-------------------------------------•---•------ ------------------------------------------------------------------------------------•----------------••------------•------- ------------•-----•---------•--- F. ______________________________________._.___._________________.___- -_._.-.._____-__________---____.____-__---- FINAL INSPECTION BY-------------. - Z3 _ Date------ - ------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M f0-52 Revised W-2100