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•�uo�V fi Permit No.�_-'-��-----�--r� 6 _V APPLICATION FOR SANITATION PERMIT / �j (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Loca4 Health District for a permit to construct and install the work herein described. This application is made in compliance with County r finance No. 549. rrl-. — 6AG.aY --------------------- - . JOB ADDRESS D LOCATION. - �- ----- ------------ -------- -4—� U Owner's Name_ ------ ----- '- - - ---------- ------------------ • Phone ------------------- t-----.------ # - , ��" � -------------- -- ------ ----- - Phone----------------------------------- Contractor's Name-- ---- ----------------- ------------------------------ Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ ❑ rr t I �I Number of baths _--!____ Lot size -�-- -- c5'O---------------------------- Number of living units: -I_____ Number of bedrooms _� �"" ` Water Supply: Public system ❑ Community system '❑ Private ['Depth to Water Table -------- ft. i Character of soil to a depth of 3 feet: Sand Grave{ E] Sandy Lo;/No f Clay Loam E] Clay ❑ Adobe []Hardpan ❑ f =.a Previous Application Made: Yes ❑ No [t7I New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ------------------------------ - , Septic ank: Distance from nearest well-_ __ .___._Distancelfrom oun g`�fifon___._ .-_ Mater ` No. of compartments-------------- --------t--Size_ -X+�-_---d Liquid de�th--------------�Y_----Capacity-- -- -Q - r f Distance from foundaf r __ 1_--Distance to nearest lot lir��_ "- Dispos Field: Distance from nearest well____ __. _____ . If lf{ V .Len +h of each line--- Number Width of trench------- ---------------------- Number of lines---------- ---- - g ----"- r yy i Type of filter materia -' - -- --.--- 'epth of filter material______-! _ _ ______Total length--------�-�.(/-------------------- Type --------- -- �;---- earest lot line----------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to n ' ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well________________Distance from foundation_____--__._____.__.Lining material-____-______________--________ ❑ Liquid Capacity--------------------------- Size: Diameter--------------------------------------Depth--------------------------- Privy: -------------------- --- ° gals.. Privy: Distance from nearest wel--------------------------------------------------Distance from nearest building._-_____------------------------- ❑ --------- ----------------------------------------------------- ---------•-------- Distance to nearest lot line________._________.. -- a -------------------------------•----------------"------------------------------- amodeli: g nd/or repairing descrie�---- -------------"-- -- .. --------------------•.�-•-------------------------------------------------------------------•-------------- -•-------•----_.------------------------- -----------------•---------------------.----------------------------------•--------•------------------------------------------------------------------------------.-------------------------- ------ her4cey that I have prepated this application and that the work will be done in accordance with San Joaquin County ► ordinancews, and rules n egulations .``f the'San Joaquin Local Health District. -----------------------------------------------------(Owner and/or Contractor) Si ned ----- ---- --- ----- B -- ------ --y------ :. Title---------------------------------------------------------------- Y(Plot plan, si of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B _ DATE_,_✓. --------"-------------------"" DATE--- REVIEWED BY--------------------------------- - --------------- DATE---- ------e--------------------------------------------- BUILDING PERMIT ISSUED----------- U ---------- - ---------- ---------- -- -- Alterations and/or recommendations:---------------------------------------------- --------"--------- -----� --- -- -------------------------- ---------- - --------------------------- - --------- ------------------------------ - - 1 -- y ;�_ i-1Z. , ,! S- -, �f_ �' , � Date---------��-----3'-------------------------------------------------------- F1NAL INSPECTION BY------ = f---- ----------- ------ i SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y ES-9-2M 8-51 Revised W-2100