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02— APPLICATION FOR SANITATION PERMIT Permit No. `�} r1 in Duplicate) /Z ` Date Issued L__ __ /:S3 (Complete P a Ap cation 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 wjA Cpu #y rdinance o. 5� ` JOB ADDRESS LOC l0 f (/�' ------ -- ---- M R Owner's Name-- '"__ _ Phone,3 -� ---� --------- AddressIJ '------_Y------- --- ----- .-----•- ----- ------•------------- ------------------------••----------------•------------------- Contractor's Name_.- .. ... ....... --- --------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of living units: ..'---- umber of bedrooms -�-!___ Number of baths ._/____ Lot size __-i�_.�/ K_1V___________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ - Sandy Loam Clay Loam Clay Adobe [Er/HardpanF1Hardpan Previous Applica+ion-Made: Yes ❑ No 2� New Construction: Yes [(No El❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-public.sewer.is_available wifhin.200.feet.) Septic nk: taf twell�`Y----------------- p ,_ ________.D stance from foundafion I ____ !_ __._Material------------------------------------------------ 'p ____-------___.._.______„_________F_..__ T-._s_'_ __ Noocom artme eq--� �eth----s------------- ----Capacity------------�` ___, --------------------------- D is istan.,Dce from foundation__!_ _� tance to nearest lotine__. e . . Number of sines___.___ _ -------._..____._ _L'eiicfth of each line - W__-Width of trench______ ♦ ` � Type of filter materi _ epth of filter material_________ --- -------- otal length------------- _fJ----- ----------------- f•: +�_ � _ # r Seepage Pit: Distanceitonearest well_.__'---------------_Distance from-foundation--------------------Distance to nearest lot line_.____.______.__ ❑ Number of.pits----------------------Lining material-------- -------------.Size: Diameter------------------ ----Depth---------------------------------- Cesspool: Dist nce,.from.nearest well------------------Distance from foundation--------------_-___.Lining material__.-_.-------------------._---------- Size: Diameter_r-_�.,-- --------- --------De th_------------------------- - - ❑ r� - - ----------------Liquid Capacity------------------ ---------gals. Privy: Distance from nearest well ________________--------------------------------Distance from nea/est b0cling------------------------------------------ ❑ Distance +ownearest lot I#ne.— `"'= "------ -------------------------------------------------------------------------------------------------------- ------ It x Remodeling and/or repairing Idescribe)----------------------------------------------------------•-•------------------------ --- { I ------------------------------------------------------------------------------- -------------------------•---------------------------------•----------•------------------------------•-•----------- ---------------- I ----------------__--------------------- I --••---------------------------------------------------------------------------- -- I herdby certify that I have prepared this;application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and `rules and regulations of the San Joaquin Local Health District. (Signed)_ ---� ��_-- �*''---------- ------- [Owner and/or Contractor) -- -------------------------------------------------------------- i 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 APPLICATIONACCEPTED BY--=V_._ ------------------------------------------------------------------------------ DATEREVIEWED BY------••-------------------•- ---- ----------- --------- -----•- --- --------------------------------- DATE-------�--•------------------------------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------ ' Alterations and/or recommendations:------- -- ------------------ ---- - ---------------------------------------------------- -----------_-•---------------- -----•----------------------------------------------------------------------------------------------------------------------------------------------------- -----------------•------------------ -------------------------- =-----------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------•------------------------ ------------------------------------------------------------------------- ------------------------ ----------- ----------- -------------------- ------------------------------------------- -- FINAL INSPECTION BY:- ---- , /'__ � Date-------- ------------------------------- ( 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 {E5-9-2M 10-52 Revised W-2100