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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 1-Y Date Issued ___ __.� __�_ Applica-lion 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. 54 . JOB ADDRESS AND.�LOCATION__ ------- .. .. �_.____ Owner's Name `e � --- -- ------ •- --•--- --------------------------------- -------------------------------------- Phone__, ^ Address------ . . --- ........ •--•---------- ---------------------------- -------------------- Contractor's Name------------------------p -----••-------- Phone_�Ve_d-9�`sr,7_ Installation will serve: Residence lj?'*__Apar+ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I___ Number of bedrooms _s?z-_ Number of baths _-,L__ Lot size --py-__- ---------------.____-_ Water Supply: Public system B-11-Communify system ❑ Private ❑ Depth to Water Table _46�_ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes [] No [ New Construction: Yes ❑ No 0� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material_-__-.-_---___..____.__________._.____---.--_. No. of compartmenis ----f�-r-- -----.._Size--------------------------------Liquid depth------------------------._Capacity----------------------- �isposallld: Distance from nearest well___P-0_i- -Distance from foundation--------------------Distance to nearest lot [Rl Number of lines----------l----------------------Length of each line------#4'____ -------- Width of trench---v7-y-�l__-.---------------- Type of filter material___S►_/?pG�----Depth of filter mate rial.__._1/8��_____--Total length______�1?__ _____________________ _ Seepage Pit: Distance to nearest well._)b_,..........Distance from fQgundation_._J4./_-___ Distance to nearest lot line- FEK Number of pits------- -------------Lining material...MAAe __..Size: Diameter-___22-_'1__----- ------------------ Cesspool: Distance from nearest well----------------- from foundation---_-----_---------_Lining material------------------------------------- 171 Size: Diameter------------------------ - ----- ----Depth------ ---------------------------------------------Liquid Capacity-------------------------•--gals. Privy: Disfance from nearest 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, Stat ws, and rules and regulations of the San Joaquin Local Health District. (Signed)_-._,, --•--•-- - •----st_�-•---- , ---------------------------------------- --------- ------ -- - -------- -.(Owner and/or Contractor) ZejBy:_ A 7°- •------------tai+lei _. - ------------------------------------------- (Plot plan, showing size of lot, location of system inlrelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------- ------- - ----- - ---- ---- ------------------------ -•---------------- DATE.------� ---------- ---------------------•----------- REVIEWEDBY------- --------------------- ----- ---------- - ----- --- ------ ------------------------- ------ DATE-------- -Oz BUILDING PERMIT ISSUED. -----------------•--------•---------- •----• DATE..- Alterations and/or recommendations------------------ -------•-----------------------------•---------___-----_------_ ------------------- ------------- ------- ------ --- ----------- ----------------- �- --- ----- -- -------------•-------------------------------------------------- --------•--- ----------------------------------------- 1 ' 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 145446 nsw000