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` I t "b ' APPLICATION FOR SANITATION PERMIT Permit No.CZ15 -------- (Complete in Duplicate) Date Issued - / Applic ion is e y to the San Joaquin Local Health District for a per to construct and install the work herein described. This a lication is Trade in compliance with County Ordinance No. 549. 1 � r '`�'--------------- JOB ADDRESS AND LOCATION_.'_______-____---------------------- - a 'L �- - Phone----- Owner's Name--- ------------------------1-11L N 11-S. Address---------------------------------- -------------------------- --------------------- Contractor's - -- Contractar s Name----------------------------- ------------------- - Phone----------------------------------- i Installation will serve. Residence* Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms _y- Number of baths _f-____ Lot size --------- ----------------------- 1 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] ❑Gravel Sandy Loam ❑ Clay Loam El Clay ❑ Adobe Hardpan ❑ Previous Application Made: YesX No ❑ New Construction: Yes. No;Fj, TYPE OF INSTALLATION AND SPECIFICATIONS: >' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I '"�-____-Distance from foundation__ �______Materials____-/__ _ _____ _____----�------ Septic Tank: Distance from nearest well No. of compartments-------'y__--_ ---Size----- _ �� Liquid depth---------- ----- Capacity-----�--- - -- Dispos I Field: Distance from nearest well___"''_'_`------.Distance from foundation_- �__:____Distance to nearest lot Number of lines-------------rte_------------=-----Length of each line--------- _--------------Width of trench___----- - -+E------- De th of filter materiaL.___I_ ��_--___Total length____________ - Type of filter material [ ,f� P Seepage Pit: Distance to nearest well______________________Distance from foundation_____________..-__-.Distance to nearest Tot line________--_______ (_ F-1 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------De th--------------------------------- Cesspool: V� Distance from nearest well______________.--Distance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter---------------------- ------Depth--.--------------------------- ------.----------- Liquid Capacity 9 ql. Privy: Distance from 'nearest welL------------------------------------------------Distance from nearest building------------------------------------------ ❑ --------------------------------------------------------------------------------------------- Distance to nearest lot line-_____-___�--__-___�_______-_._- ' ---------------- Remodeling and/or repairing (describe)_________________________ __-------------------------------------------- I -------------------- -------------------•----------------------------------- ---------------- ------------------••------------- --------------------------------------------------------------------- ------ ----- ------- -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ------------------------(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 ------------------------------------ DATE----------to----- - APPLICATION ACCEPTED BY---f------- , - ------------- aDATE----- ---------------------------------- REVIEWEDBY--------------------------------------------- ----------------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------- -------------------------------------- DATE----- ------------ ------------------------------------------ 1 ------------------------- Alterations and/or recommendations:_________________________ ------- ------------ -- - -------- I ------ ------------------------------------•------------------•------•-------------------------- �" --------------------------------- /- , --------------- ----------------------------------------------------------------- -------- �� ---------- - ------ ----------------------------------------------------------- : --------------------------------- ---- ------ ----- ------ ------ FINAL INSPECTION BY__________________ Date---- --------� ----------------------------------- SAN JOAQUIN LOCAL 'HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street S+ockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100