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APPLICATION FOR SANITATION PERMIT Permit No. .__ !___ _.___.- (Complete in Duplicate( Date Issued ---- Applica*ion 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 Ordinanc No. 549. JOB ADDRESS A LOCATION--- _ _. _ -------- ------ ------------ ---- fi ��rr� Owner's Name-- y-�_--- Q__� - = �• ------- �,� ---- ------------- P a---(47,14• --T-1----------- ----------• [ - ------- ------------" ...------ `-- =- -- ------------------------- Contractor's Name + .. -^.� - t Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I__-_ Number of bedrooms-__-_ Number of baths ._ ____ Lot size _ _f�_.C►____x___.4� _._______________________ Water Supply: Public systern Z' Community system ❑ Private ❑ Depth to Water Table ________ ft_ i i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado6e Hardpan ❑ _Previous Application Made: Yes ❑ No New Construction: Yes No El' TYPE OF INSTALLATION AND SPECIFICATIONS: > , (No septic tank or cesspool permitted if public sewer is available within.200 feet.) Septic Tank: Distance from nearest weir-r+._.-, _Distance from foundation_J.Q------------Materiai__A-1-- No. of compartments_.___,______________Size__ ` __ _ -------Liquid depth---- -------__---------Capacity----Tao-_____ Disposal Field: Distance from nearest well_._. _!7 _Distance from foundation.--j-f.) to nearest lot line___________.. Number of lines_____- Y________ ________ ___Length of each line-----4--�------ ---_.Width of trench___ :_ _ ------------------ C` Type of filter materi _ Depth of filter material..-.�__ __ _____Total length------)._- -- ___--___________-__- -`� Seepage Pit: Distance to pts --ming rest well--- --- '.-Distance fr m f ndation___________________ Distance to nearest lot line r.-------------- Numberof rf--------------- material---- ---Size: Diameter---- ------ Depth__---A�1 ------ Cesspool: Distance from nearest well-------------_....Distance from foundation--------------------Lining material_-_ __--___-_____-___--_-__-_--___. ❑ Size: Diameter----------------- ---------------------Dept h----------:-----------------------------------------Liquid Capacity-----------------------------gals. Privy: Distance from nearest well--------------_----------------------------_____Distance from nearesi-'buildin -------------__--, ❑ Distance to nearest lot line-------------------------------------------- Remodeling and/or repairing {describe):- -------- _'1 --!_"�"----}-•-------• 1 , .. Ii I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of th San Joa uin Local Health District. , 4 (Signed)... /Ira - snr ,.. __Y -' (Owner and/or Contractor) By:--------------------------------------------------------------------------------------- ---------I--- -----------(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 APPLICATION ACCEPTED BY--------------------- ----------------------------------------------------- DATE--------5-- ----.-- REVIEWED BY-------- -------- -------- DATE------------ BUILDING PERMIT ISSUED- •----- ------------------ - ------ ---------------------------------- _---------------------------- DATE--------------_-- ---------------- Alterations and/or recommendations:---------- � ------------------------------------- •---------------------- �--- -------- ----------------------------------------------------I--------------•----------- --------•---•--------------•------------------ ---------------------------------------•-----------------------------------------------------------•--- -------------------------------------------------------------------- ----- ---------------------------------------------------------•-- ------- --- --- --------------•------------------------------------------ -----•------------------------ FINAL INSPECTION BY:------- ------ Date------_/v---"-- - u--�- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E ES-9 145446 ATWO06