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AP" ICATION FOR SANITATION PERI Permit <br /> (Complete in Duplicate) Date Issued'._ _, <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION---•4 --`--- --- - --- --------- ...... I ------- -.........------------------ - -- ------- <br /> Owner's Name------------ / - -'- -------- ------------------ ----- ------------ ........................ Phone L ------- <br /> Address.---------/�-�-?' ''t- .. ------------------------------------------------------­-------------- _.......... ................... <br /> Contractor's Name -->V_......................................---------------------------------------------------_-----_---_---------------_-. Phone------------------ --------- <br /> - - - - <br /> Installation will serve: Residence 01 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: :�... Number of bedrooms o - _1_ <br /> .. Number of baths _.__ Lot size 5 OZxM----....._.._....................... <br /> Water Supply: Public system [ r Community system ❑ Private ❑ Depth to Water Table -------- ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe l T Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [9 New Construction: Yes ❑ No ❑ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public,pu,b-Ilic sewer is available within 200 feet.) / <br /> Septic Tank: Distance from nearest well..!�1.--------Distance from foundation-1.0--------._.Material_/? �a�R--___ <br /> 9 No. of compartments____-t ........._._Size.7..X3_> ..........Liquid depth____3�[, :..._____-Capadty..T�-d..:..__ <br /> Disposal Field: Distance from nearest well_,------Distance from foundation../._ _.__.___.Distance to nearest lot line�_�-._.. <br /> 10 Number of lines_..--------------..........Length of each __.__....Width of trench.Z_Y::_.................. <br /> r Type of filter material_.-.0 ._.,.--------Depth of filter material-.._/.�-...._...._Total length___�.l_2_.._._...__-.._----- <br /> Seepage Pit: Distance to nearest well----.......----------Distance from foundation....................Distance to nearest lot line----.---------_ �' <br /> FI -_ ...... <br /> Number of pits_______________ ._.Lining material Diameter_....__._..._.-.-__.-Depth.___.-........_..........___-- <br /> Cesspool: Distance from nearest well----------._----Distance from foundation....................Lining material....._.._....._---------....—... <br /> ❑ Size: Diameter--------_-----------------------___.Dept -..................-.-_-....._.__.__________Liquid Ca aci als. (� <br /> L Privy: Distance from nearest well - ._-_-...__. -_.-----.............Distance from nearest building.___--------------_--__._------ _. <br /> ❑ Distance to nearest lot line------------- _. _._•__-------------__---_--• __ _ - _. ._ _. ____ <br /> Remodeling and/or repairing (describe) L C__. �__c-- - LLr . - <br /> -----•---------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> L ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed) ( `/ / _ --------------------------------- - _(Owner and/or Contractor) <br /> By:------ -------- -------- -------------------------------------------------- - -----------------------(rifle)--- .. -- ----------------- <br /> (Plot <br /> -(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY - - ... - - - ---------- . DATE } }- ------------------ <br /> REVIEWED BY = - - -- ------------------------- -------------_...-- DATE !�- •----- - --....---- <br /> _BUILDING PERMIT ISSUED - --------------- -------------------•------------------------------------- DATE---------•------------- - — - - <br /> Alterations and/or <br /> -------------- -- -- --- <br /> -- r-e-commendations:.._--------------------------......-----------------_--------_-- ------------------------------- <br /> ------------------------ - <br /> � ,r/... <br /> ----------- - ------------- ` " - <br /> .—. -Y-O <br /> Clf. v-------------- -----.....-..........-- ----­---------- -•----.... .. - <br /> ..................... <br /> --- ----- -----_-----------.............------............-_.......------................�-......---------------------•--------------------- -------------- <br /> IFINAL INSPECTION BY:------ 'I>�,J ` ` -...........------- Date *2) Js -- - <br /> --- ------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> L ES-9-2M 8-51 Revised W-2100 <br />