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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) � -� Date Issued �__ �.?`.0# 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 rdinance No. 549. x.78 w�y S. asPE;e.40t _ JOB ADDRESS AND LOCATION- Owner's Na _ -----•-------- ----------A -------•- --- -- - Phone - ----•-- -- -- - ----- Address.___ - r F -- - -.�. Contractor's Name_______ __________ ___ _ Q ----------------------------------- ----- ---------- - -- - -----------.1 Phone Installation will serve: Resident Apartment House ❑ mmercial [ITrailer Court C-] Mote! Q Other Number of living units: -__l---_ Number of bedrooms _-�_ Number of baths --)-___ Lot size __------_ Water Supply: Public system E] _Community system ❑ Private Depth to Water Table - Wafer Character of soil to a depth of 3 feet: .Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes [] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep i Tank:. Distance from nearest well--L��o_ Distances fou tion_--- - ----Mat ial- �_�_�___-�---- - No, of compartments..--_2I- - ------------Size_ -•_--_ __Liquid depth-------- -- ci Capacity_. - Disposal Field: Distance from neare t well_--� ._Distance from foundation- �'�/ .-_-__.Distance to nearest lot I�e- ,�- Number of lines---.-- -__-- Len Length of each line------ _ _ g -�--Q Width of trench _ _ - �: Type or flier material--��_ _ _____ Depth of filter material---_ �------Total length----I�`�__-_�_--_____ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------..--..Distance to nearest lot line-_---_------- - {�T ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------ -----Depth----------------- ------- �v. ---- esspool: Distance from nearest welL________________Distance from foundation..__.-- _---_-._--.Lining material------------------------------------- =_ _---..----___-----__-_-._�` ._ ❑ Size: Diameter--------- ------- ----=- -----------Depfh----==- -------- .? - . t — I - �. .� ._;;— �x-:..—� .:--- _Liqu.id Capacity- y--------------_..:gels: Privy: Distance from nearest well----------------_-.---_ ------------------_Distance from nearest building ❑ Distance to nearest lot fine------------------------------ Remodeling and/or repairing (describe):__-_- .e±, ' t I ` --`--.---�---------- ----------------- r ---------------------- --------------------------------------- •- - -- ____----- J-Yi/'►-__-•• -_ ----•- --- -- ,7•`r---------_-_ - -___-----_----_-_--__-_--_--- ---------------------------------- -------------------------------------- -------------------------------------------- -----------------------------•---- - ----------------------------------------ty ;I I hereby certify that I have pre ared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, andpruan�6gulafionsi of the San Joaquin Local Health District. ($igned - � � I (Owner and/or Contractor) Sy:------- -------------------------------------- ---------------•---------------••--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 REVIEWED BY----------------- -------------------------- -------- -- -- - DATE----=- -,►- "' -- --------------------------------------- BUILDlNG PERMIT ISSUED-----------------------•------------- t�--• -------------------------------------- -------------•-------------------. ----------------- 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, Gelifornie Tracy, California ES-9-2M ; Revised W-2100