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1 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued -----4*1411 A �plica4k is hereby made to the San Joaquin Local Health District for a permit to construct and install the," k h4in described. This application is made in compliance with County Ordinance No. 549. _14 JOB ADDRESS AND LOCATION------- -- ------------ --------------------------e------------------------------------------------ Owner's Name---- ........ .. - - ----- - -------- -- - ------- ---g--- Phone- -- -- ----- ---- -- -------------- - --------- ------------ ------------------ ----------- .......I---------- Address....../l/_49------ ------------- -- . 7 - 7-9 -7 Contractor's Name----- -- ---- --- ---- - --- -------- ------ Phone- ------Z____ Cher Installation will serve: Residence Apartm t House E] Commercial [D] Trailer Court' ❑ Motel ther Number of living units: --- Number of bedrooms Number of baths,-,/----- Lot size ------fi_-11'A_X_1,_V___4-------------------------- Wafer Supply Publicsysfem Community system El Private F1 Depth to Wafer Table ft. Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam E] Clay'Loam El Clay F] Aclobeo Hardpan E] Previous Application Made: YesNo D New Construction: Yes); ' No E] FHA/VA: Yes D No J��, TYPE OF INSTALLATION AND/SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 1 / )al- -- Septic Tank: Distance from nearest well_,P_--,T--__Disfance from f''unclafion,14e----------Mater - -- No. of compartments----- —--------------Si,e_J/_�<Ai"1'_,__1-------Liquid depth------e_` --- -------Capacity...___ ----------- ------Distance to nearest lot linp-- DisRosal Field: Distance from nearest weIL-4 --- Distance from flundafion-/—e---- Number of lines-------/---------------- Length'*of each line-------- ---- �/4 -----------Width of french- fr .k /0, 11 Type of filter filter material-----e!�--------------Total length------------r----------------------------- Seepage Pit: Distance to nearest _____Distance from jfodation___ Distance to nearest lot line 01----- -_ Number of pits.----/-------------Lli'ing material,,,71VI-�_ __Slze: Diameter-------- ..........Dept h--------IX-------- --------- j: Cesspool: Distance from nearest weil---- /Distance from foundation-------------------Lining material__ -__------------------------------ CEl Size: Diameter------------------------------- -----Dept h------------- --------------------------------------Uquid Capacity----------------------------gals. �rivy: Distance from nearest well____________________________________________ ---Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line------ -------------------------- -- --- - ---- ----------- ------------------------------------------------------- -------- ---- Remodeling and/or repairing (describe) - - ------ --- -- ----- . ..... ------- ------ - -- ----- -- --- -- ---------- ----------------------------------------------------------------------------------------------------- ---------------------------- ------------------------------------------------------------------------------------------ -------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- Jb - -----------------------------------------------------*--------------------•------- -----------------*--------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and at the work will be done in accordance with San Joaquin County ordinances, S laws rules a re ations oft San Pquin al Health District. ---- ---- ---- ------ ----(Owner a r Contractor) (Signed By:-------------- ----- ---- - --- --------------------------------------------------(Titl Ic---- ------ ------ -- ------------------ (Plot plan, showin s o 1, 1 1 n of sys em in.relation to wells, buildings, etc., can be plfil?ed on reverse�eii. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- --------------------------------------------------------- DATE----------------------- --- ----------- REVIEWEDBY-----------------------•------------------------------- -- ----- ---------------------------------------------- DATE------ ------- 2_1 --------- ------------------- BUILDING PERMIT ISSUED------------------------- -- 1- ---------------------------------------------------------- DATE-----0------------------------------------------------- Alterations and/or recommendations--- ----------- ----------------------------== ---------------------------------------F--------------------------------------I—----------- ------------------------ii-- ------------ ------------------------ ------------------- --------------M----------------------------------------------------------- -4 -------------- --- ------ ----------- ------------ ----- - --- - ------ ---- --------- ------------------- ------------------------------------------- - - ------------ -- --------- --------_---------------------- --------------------------------------------------------------------------- ------------- ------- -- - ------------------------------------------------------------ ------------------------------------------------------------------------------------------------I------- 4 FINAL INSPECTION BY.. ----------------- -------- --- Date--//_ _nrk�------- ------------------------------ 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 ES-9-2M Revised 1.57 F,P.CO.