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APPLICATION FOR SANITATION PERMIT ' Permit No. -- .` ............. {Complete in Duplicate} � 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_.. I _--c _,__ + . .- ----- ----- -- ---- - -- -- ---------------------------------- Owner's Name-------------------------------- 1„ ..... f�+'t Phone Address-------------------------------------------- �_ x .... I--.--- ----------------------------------------•-------------------------------- Contractor's Name-------------------------------- ---------------------------------------------------- Phone----- r. �? Installation will serve: Residence' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /----- Number of bedrooms _2-ow_ Number of baths ._I__ Lot size --________________ Water Supply: Public system JK Community system ❑ Private ❑ Depth to Water Table 4_0 ft. Character of soil toa depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,L Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes [j No ❑ / �� n TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publ11 ic sewer is available within 200 feet.) re—ptic T nk:� Distance from nearest well--------`{------Distance from foundation-------------------:Material________-______._________.____.________._.__.. No. of compartments------------------=-------Size-------------------------"------Liquid depth----------- ---- ---------Capacity------------------ Disposal Field: Distance from nearest well/------Distance from foundation__9____.-------- Distance to nearest loft line_____'. Number of lines--------------/-------- -----Length of each line-------' Q- --------Width of trench._"a44/w----_----.___ Type of filter material----?_y "("__Depth of filter maferial_____J$----___.___Total -length-------/___a_•-------------- �wy Seepage Pit: Distance to nearest welL.f__!} ..__.___Distance fro fou ndation___._..__------Distance to nearest lot line__. ._. x Number of pits______ _________ Size: Diameter-- Lining material Depth--, ---------------- Cesspool: Distance from nearest well--_.__.____._Distance from foundation_-------------------Lining material-----------._______.______.__._-.-_. ❑ Size: Diameter------------------------------ - --- Depth----------------------------- -"---"----------------Liquid Capacity-.-.------------------------gals. Privy: Distance from nearest well---------'---------------------------------------Distance from nearest building-------------------------------------_.-_. ❑ Distance to nearest lot line------ --------------------------------------------------------------I----------------- -------------"------------------------.-------------- Remodelingand/or repairing (describe):------------------- --------------------------------------------•-------------•-----------------•-----------I---------•---------------------------------- * -------------•••--------------•--------------------••--•--------------------------------=----------•-••----------------------•--------------------•---.---------------_--------"---•--------------------------------------- p -------------I----------------------------------------••- --------------------•---f.-------- . ------------- I hereby+cerifhat I have prepare this application and that the work will be done in accordance with San Joaquin County ordinances, S , and rules and r dations of the San Joaquin Local Health District. _ _. __ . Contractor(Signed)--------- - -- - - - -----------------: I -- Title 1J? By -- ------ { } +� (Plot plan, showing a of lot, focatio�n�o♦ ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B -------------"------ DATE_:—.---------------- ------------:------------------- f 1 ' 3 REVIEWED BY------------------------------ - - -- -- - - - DATE---r'��----- - --------------------------- VBUILDING PERMIT ISSUED------------ _________________ DATE------- ---- ;I is andAor rec m�S�l tions:. s - � ---------� r: r ---_------------ --- - ----- - j� { P. __ _ 5 -- ---------------- -------------- ------------- ------ --- - ----- ---- U---- -------------- ----------------------------- ----------- ________ ______- • 1 FINAL INSPECTION BY: � _ / .'. Date......_-- 57!'------------------------------------------ `l 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 i ES---9-2M 10-52 Revised W-2100