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APPLICATION FOR SANITATION PERMIT P rr, (Complete in Duplicate) Date IssuedAis 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 LOCATI N----, ��G Owner`s Nam _ � Phone_ �0�._ q Address ------ = / --- Contrac r s Name_______ _______ Phone -------- - ------------------------------------- --------------------------- • Installation will serve: esidenc� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ___I___ Number of bedrooms s.,� __-- Number of bath _-- Lot size _ __-- _-��j --------------------•-- Water Supply: Public.system ❑ Community system ❑ Private Depth to Wafer Table ___�ff. q Character of soil to a depth of 3 feet:} Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa"m ❑ Gay ❑ Adola&v Hardpan ❑ Previous Application Made: ,Yes ❑ No0' New Construction: Yes'❑ N9-Er TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet,) Septic Tank: Distance from nearest wail____________ ___DI,sf ante from foundation------------- ___ Material______________ tments Disposal f5 O al� DiOstance from well -Q size Liquil.depth -------------------------Capacity 'I p _ isfance from foundation _�__l�'_ .Distance to nearest`lo { Number of lines___'_____ Length,of each line_____ Width of french __: ____`_______.... Type of filter materia ___Depth of filter material--- �_�_ Total length________ __C7__ .______________ - -. - Seepage Pit:. Distance to nearest well----------------------Distance from foundation____-_________`____.Distance to nearest lot line_:_______________ Q _ Number of pits----_-----------------Lining material-----------------------Size: Diameter-------.---------------Dept h--------------------___----_ Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material--------_--------._,_________________- ❑ Size: Diameter--------------------------------------Depth---------------------------•------------------------Liquigl*Capacity-----_----------------------gals. Privy: Distance from nearest well---------------, _______ _�___________________Distance from nearest building_____ :__z_.----------._.___.___________ . ❑ ; Distance to-nearest let line ----------------------- ------- -- -------- ----------------------------- Remodeling and/or repairing (describe):------------- --------- ......•---- --- ----- -------•-------------------------------------------- ------------------------------------------------------ ------- ---------------------------------------------------- ------------------------------------------------------•------------------------------------------ I hereby certify that I v p ared this application and that the work will be done in accordance with Sqn Joaquin'County kt ordinances, a ws, an es d regulations of the San Joaquin Local Health District. (Signed)________ ______ - - L-L ___.(Owner and/or Contractor) Py-------------- _. ._...Lai,-_ r_ .�_____-_ _ -_______________________________________________-___ ________________-_-_-_____(Title)_- t4 (Plot plan, showin' ie of to+, Iota+ion of system in relation to wells, buildings, etc., can be"place n reverse side). ( FOR DEPARTMENT USE ONLY ti APPLICATION ACCEPTED BY..Q_ --------------------------------------------- ----------- DATEC REVIEWEDBY------------------------------------ -----------------------------------------------•---------------------------- DATE-- - BUILDING PERMIT ISSUED----------------- ------------------------------------------------- -- = DATE = = Alterations and/or recommendations--- --------------------------------------------•----------------------- -------------------------------------------------------•-----------:------•------------------------------------------------------------------------------•------------------------------------------=-----------••----------- --------------------------------------------------------------------------------------------LL---------------------------------------------------------------------------------------------------------------.... -------------------•---------------------------•--- -----•------ ---------------------- �.� �. . y -•--------- ti•---------------------•-• ---------------------------------- r F1NAL INSPECTION BY: Date------------ -----�-----�---------------------------- ,SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street .300 West Oak Street 132 Sycamore Street 814 North "C" Street' Stock}on, California Codi; California Manteca, California Tracy, California i ES-4-2M 8-51 Revised W-2100