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Permit APPLICATION FOR SANITATION PERMIT f (Comp e e in up i Date ,Issued Applicaa-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 Ordi ante No. 544..: M a. k _______________---------------------------------------- __ ----------------------------- JOB ______.________._ __--__.-__ JOB ADDRESS AND LOCA 10 /---------- - f r OwnersName ------- Q ---------- ---------------------------------------------------------- Address------- `'.I--- ------- -----------------------------------------------•------------------------------ ,(� / -------- Ph __ _�z =�-------------------- o Contractor's Name--•---°---------------• ------------------------- •- Installation will serve: 'Residence Apartment House ❑ Commercial ❑ Trailer Court Mot I ❑ Other Lot size "F�--------------•--- pit Number of living units: __f--- Number of bedrooms __/___ Number of baths _. . Water Supply: Public system ❑ Community system ❑ Private 2 ---Depth to Water Table JQ ft. Character of soil to a depth of 3 feetI Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ .Adobe E] Hardpan ❑ Previous Application Made: Yes [INo New Construction: Yes No ❑ + TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cessroml pe6itted if public ewer is available within 200 feet.)f //}} c ��.?-- -.Material --- ------ ` Barest well___ --6-a -- Dista ce r foundation._.-_ _ �� Septic nk: ;, ' - " " -Capacity-__ - No. of compartments_------------Sizen._----Liquid depth-----------_ -- t , Disposal field: Distance from nearest well... Distance from foundation.___S___._.Distance to nearest lot lie_____ Number of lines--? ---------- Length of each line -____ _.. Width of trench .___a y........................ - i Type of filter material---�°�-=--Depth of filter mate nal________________Total length-__ ------ �---------------• ... p ._ p _.-_..Distan e to nearest lot line__�_�_______ See it: Distance to nearest well_._/_ -______----Distance fro fo dation__-__ L' Size: Diameter ---`3 ----------- Depth s: 4--------------------- S Number of pits ------ ---Y ------------ Lining material____ 1 J Cesspool: Distance from nearest well ----------------- Distance from foundation.,. -- -------- . Lining material_______._____..___.____--___________. 9rals.---------------------Liquid Capacity--- --------------- ❑ Size: Diameter--------------------------- ---- Depth ------ ._Distance from nearest building ------ ------ Privy: Distance from nearest well -------------------------- -------------------- ❑------------------ ----I--------- Distance to nearest lot line ------------------ ------------------ ---------- 1 Remodeling and/or repairing (describe]:_----------------------------------------------••---- -•----•------z--------------------------- ----------------------------------------------- •-•------• --------------------- ------ ----------------------------------------------------- --------------------------------- ._._._______ k ____________------------------------ _------------------------ .;.---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State w fiand rules and regulations of the San Joaquin Local Health District. i t fi j --- --- - �-------------=-------- on rat ^�:� + r and/or C or (Signed) ; - -------=---------- ---------- ---=---------- By: .................. e)----- -- ----- ----------------- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- --� DATA -r --- - ------------------------ - DATE-------- ---------------•--- -----------; - - REVIEWEDBY ---------- ----------- ------------------------------- --------------------------- - , BUILDING PERMIT ISSUED------------ ----- -------------------------------------------•--------------- DATE--------------------------------------------------- ____________________________ Alterations and/or recommendations: __.___,___------------------------------------ ------------------------ ------____________ ----------- -----••----------.-•--------- -------------------•----- ------------•----- --------•----------------------------------- - FINAL INSPECTION .BY:._----- Date- ------------- - ------ -----• ---------------------•- --------------••---- I � � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Tracy, California Stockton, California Lodi, California Manteca, California { ES 9-21v1 : Revised W-2100