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APPLICATION FOR SANITATION PERMIT Permit Nc;.4��1,,;�r . t- `= {Complete in Duplicate) --I-- ~S� 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 Count y Ordinance No. 549. o ( ---- -- -- ---------------- JOB ADDRESS AND LO ATl N------ ---------------- - x m`_.! - Phone------------------------------------ Owner's Name------------ -------- •- Address-------------------------- _.. Pho Contractor's Name-..------- --•---' - 4 ne - - -- ------------------ Installation will serve: Residence Aparfm f House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ,, f o---X.---�e----------------------- Number of living units:'_f____._ Number of bedrooms -=1-. Number of baths I---- Lot size __ _. Water Supply: Public sysferri' ❑ Community system ❑ Private A. Depth to Water Table *Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobek Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No M TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted-if public sewer is available within 200 feet.) I. from foundation-_._.-----_-_---__-Material-___-.-_-__---_--_--__.---__------.-----------. Septic Tank: Distance from nearest well_________________Distance ❑ No. of compartments--------- ---------------Size--------------------------------Liquid depth--------------------------Capacity----------- i Disposal Field: Distance.ft•om nearest well____-------------Distance from foundation--------------------Distance to nearest lot line___.._______.___. Number oi'liries----------------------------------Length of each line------------------------------Width of french.----------------------------------- Type -------------------------- ❑ Type of filter material-------------------------Depth of filter material---.-------------�----Total length---------------------------------- ----- # . . i .___...Distance to nearest I t li e__l�-_-- _ Distance ora fo dation_ ____. ------ Seepage Pit: Distance to nearest well _,�------ .-- t pe th__ - min material_j LCr ___ -Size: Diameter- ----- p Number of pits._(�'4��..-�L� 9 - Cesspool: Distance'from nearest well-----------------Distance from foundation__.___._...-------.Lining mater'sa4_______-_- ---- als '� EJ Size: Diameter. " ----- �------ - ----Depfh-------------------------------------- ----- - --- Liquid Capacity... Privy: Distance from nearesfi well________________________..._ __ -----------------Distance from nearest building------------------------------------------ ❑ Distan ---------------- -- ceito nearest lot line------------------------ ------------------------- ------"-"""- Remodeling and/or repairing (describe):----- __-__ _ ____. __�- - ---- ---------•-------- y------------ ------------I----------------------- ---------------•------------------• -------------------------------•-----------------------------•---- ------------------------------------------ ------------I -•-------------------------------------------------------------------------------------------------------------------- - Ihereby certi4, 1,1 , prepared this a lication and that the work will be done in accordance with San Joaquin Countyordinances, State lvs s and regulatio of the San Joaquin Local Health District. _ ___- _-(Owner apd/o Ca actor------ L g - -- By--------------- - ------ ----- [Plot plan, showingcation of system in relation t wells, buildings, etc., can be pla a on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED �` _ ----- DATE_______________ _ _ BY = Y `/ � ----------- DATE------------------------------------••--------------•------- REVIEWEDBY--------------------------------------------- ------------------------------- ------ ------------------- - BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------- Alterations,and/or recommendations ----------------------------------------- -------------------- = ----------- --------------------- -- ---- ----------------------------- ----- ------- ---------- lJ �C✓� -- ----- ---- --- ------ ------------- -- /��/ -- -----�-- -----------• FINAL INSPECTION BY--------- ------------•--------------- --- --- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT Soo West Oak Street 132 Sycgmore Street 814 North "C" Street l30 South American Street Trac California Stockton, California Lodi, California Manteca, California y. ES--4-2M 10-52 Revised W-2100` -_