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1 P. i � F ` . APPLICATION FOR SANITATION PERMIT Permit No.o•Z.k__%S----------- (Complete in Duplicate) b w Date Issued ----�-0- .d �jl 11 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. 49. JOB ADDRESS 4------- - ------ A D LOCATI(c�N__. __Q_ _- Owner's Name------ -- ......... .------ .-- -- ----------- Phone-------- Address-----—V-1. ------------------•------ Contractor's Name--- --- -------A ----- ------------------------------------------------------------ ---------------------------------------------- Phone----------------------------------- Installation will serve: Residence!! Apartment House ❑ Commercial ❑ Trailer Court ❑ -`Motel ❑ Other [i]_ Number of living units: ------- Number of bedrooms _ Number o 'aths ___I___ Lot size __ I_X-i- - �____________________ Water Supply: Public system E] I Community system F1 Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand _ Gravel E] Sandy Loam r Clay Loam [-] Clay E] Adobe �ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ;No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p li er is available within 200 fe N.Materiall Septic Tank: Distance from nearest well_ .Distafro foun . iron� ___________________No. of compartments-----_-__-- __ .___Size _(i_� Liquid epth________ �__----_-Capacity___ j-- Dispos I Field: Distance from nearest well- ------Distance from founda - n_______ ____ Distance to nearest loft"lin�__! ------ -Length ____- Number of lines___________ ____ _ ___ _Length of each line__ G --- _:Width of trench-.__.__ �_ Type of filter maferi ______ __ _ ____D'epth of filter materfai________ _________Total length---------- __ ,__ ___-__- ' Seepage Pit: - Distance to nearest.well----------------------Distance from foundation--------------------Distance to nearest lot line___-.__-_____.__ [] Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________-_-_---------_ " ❑ Size: Diameter--------------------------------------Depth---•-----------------------------------------------Liquid Capacity------------------------------gals. Privy: Distance frominearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- - Remodeling and/or repairing (describe):------------------------------------------ ------------------------------•--•------------•----•-•----- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this applicdtion and that the work will be done in accordance with San Joaquin County ordinances, State laws, andjules and regulations of the'San Joaquin Local Health District. VI ------------------------------------------------------•(Owner and/or Contractor) By=----------------------------------------------------------------------------------------------------------------------------------(Title)------------------------------------•----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------- DATE ----------------------- ----------- REVIEWEDBY-------=---------------------------- ---- -- --------------------------------------------------------------------------- DATE----- BUILDING PERMIT ISSUED---------------------------------------------------------- ------------------------------------------ DATE------- Alterations and/or recommendations---------------------------- - ----------------------------------------------------------------------------•---------------------------------- --------------------------•------------- ----- --- ' ----------- -----:-/---- { �` -- { r- t :3 . : = ----------------A----------------- - ------------ ------------------------------------- FINAL INSPECTION BY-------- ------- ---------------- Date------------------- I •v 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 8-51 Revised W-2100