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FOR OFFICE USE: I 4! --------------------------- - ----------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. _ -------------- -- -------------------------- ------- (Complete-in Duplicate) ' This Permit E I xpP.res if Year From Date Issued Date Issued __�a- 7 r 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 County Ordinance No. 9. JOB ADDRESS AND LO ATION___' - - ____ --- -------- ----------------------•------------------ ( Owner's Name �► a Phone. - --------- --•------------------- - e----0-�----•-- ---------------------------------------- ------------- Address Contractor's Name ---------------------= .- _)_. --------J1'"C------ -------- ----------------- ------ Phone_4fo-C f4lo•D-7--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: -!-__-- Number of bedrooms _ I ._ Number of baths I----- hot sizeQ_---------. ---------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table _7-S"ft 1 Character of soil to a depth of 3 feet• Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: (If yes,date-...._,.......... ) No X New Construction: Yes ❑ No FHA/VA: Yes ❑ No A TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep n at well, ____.. ...Distance from foundation--,----------------Material Noof tompartmie s- - - . e -- - - ------Liquid deth-------- - . ---- Cpacity---------- -•----------I .- �i Disposal Ffeld: Distance from nearest well__. Z1_ --Distance from foundation---9-5.r--_-_..Distance to nearest lot line---- Number of lines_ 7r4.+<-.[f �__ Length of each fine__.___ _ � ri g �> ---_ry_---._.Width of trench---- --•---------- Type of filter material_ -----Depth of filter material---- -- ---------Total length------1719------_-- Seepage Pit: Distance to nearest well----...--------.------Distance from foundation----------------.__.Distance to nearest lot line_-_----.____it ❑�yCtSf' � Number of pits---�_------_____------Lining material__...-_.____..._.---- Size: Diameter------------.._. ----..Depth------------ -------------- Cesspool: Distance from nea _ rest well ____ ___________Distance from foundatian _....-_-_.- ----.Lining material--------------------------- ❑ Size: Diameter- Depth------------ - ----------------------------------- Liquid Capacity- -------------------------galPrivy: Distance from nearest well............ ..... --- _.._._.Distance from nearest buildin , EJDistance to nearerst lot line . ------------------------- -------Remodeling and/or repairing (descrJe):__. - --- ----------- --- --- --- ------- ----------- --------------- ----------- ---- --------------- -- --------------- ------------------------ ------------------------------------------- --------------------------------------------------------------------------------------------------------------------- ------------- I hereby certify that ! e repared this application and that A ork will be done in accordance with San-Joaquin County ordinances, State laws, an rules-- ndreguS lations f the San Jo qui ocal Health District.: --------------------- (Signed) ; ---- ------ ----------.-------•- - ------- ------------- _,-.Owner and/or Contractor) By:------------------------• - _ .f._._...- (Pot plan, showing size of o , location of system in relation wells, buildings, etc., can be placed reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---- ---- •- ----a -------- DATE__ /4 G VIEWEDBY---------------- --------------------------- --------- ----- ----------------- ------------------- ------------------------ DATE__.-. ---------------- ----------------- i BUILDING PERMIT ISSUED-------- -- - --- ------ -------------------------- DATE Alterations and/or recommendations_________________________ __ --- -------------------- --------------------------------------- -------------- I ----------------------------------------------------------------------------------- -------------------- --------- - ------------------------------------------------- FINAL INSPECTION ------ Date--------------y -- -3 ` G SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Stockton,Calffornia Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press