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APPLICATION FOR SANITATION PERMIT o� ��pp Permit Na�__D..-Q--.-�" (Complete in Duplicate) Date Issued i 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 Cwith County O"inance44. JOB ADDRESS SID LOCATION__c- 7 Owner's Nam -- ------------ Phone----------- ---•------•-------- 4 --------------------------------------- Address-------�-�- ---••- ----- - --- --- _ --- ----------------------------•-------••-------------------------•---- Contractor's Name-.--- ----- ------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court [IM t I E] Other , rr Ir f Number of living units: _j4Communify umber of bedrooms ._!-____ Number of baths .1___- Lot size _Y_ ___v__ __ ------- -------------•-- Water Supply: Public system system ❑ Private ❑ Depth to Water Table .------- ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam 2/clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ ;! Previous Application Made: Yes El [ New Construction: Yes [�No El TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public�]sWer is available within 200 feet I Septic/Tank: Distance from nearest well_-_ V__ Distance fro fours ation______________ Materia ___.____________ . Size- ------ -Liquid dept --------- ------------- from ---- -- Capacity I�� No. of compartments------------ X s /--___Distance to nearest 10 lin _��_____. Dispos Fie4d: Distance from nearest well--y--v__.-Distance tram foundation____ f Number of Fines____________ __ _ Length of each line___________ _._.Width of trench___-. --__ _____-________ ----- - -- Type of filter materia Depth of filter material_____-_f ---,----Total length--------_ (/_f_____ _ Seepage Pit: Distance to nearest well----------------------Distance from foundatison----._.-------------Distance to nearest lot line---------...____- b ❑ 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 from neare-- st well_..`:_"_"`----------------- __:_�---------"Distance from nearest building__-:.--________________ - = --� - ❑ Distance to nearest lot line------------------------------------------------------------------- ---------------------•-•-----------------------------•-------------------- + Remodeling and/or repairing (describe)--------------------------------- ----------------•-------------------------------------------------------------------------------------------...------- --------------------------- ------•--------------------•--------------------------------------------------••-----------------------------------------------•- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin"County ordinances, Statep.Jaws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- ......_- f -----------------------------------------------------------------------------------------Owner and/or Contractor) ------ ---- - - ----------- --------- ---- ----------------------- ---------------Tale (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 1 A - APPLICATIONACCEPTED BY-- -------- ---------------------------------------- ---------------------------------------- DATE�-�-------•------------------------------------------- REVIEWED BY--------------------------------- DATE ------------------------------------------- BUILDING PERMIT ISSUED--------------- DATE----- .'�2Ie ------------------------------------------- Alterationsand/or recommendations---------------------------------- --------------------------------------------------•------------- ------------------------------------------------ --- ------ --------- -------------•----- - ----------------------------------------- ------------------ • -------------------- ------------------------------------------------------------------------- ------------ -------------------------------------- ---------------------- o `� ----------- Date------ � �1l� FINAL INSPECTION BY:---------- �-------------------------- - ---------------------------------------------- �v1 f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9---2M 8-51 Revised W-2100