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/ E i ' Permit No. �.�-'S--d�- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) ..Date Issued ;---.1-/°Ua? Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. pP Ordinance No. 549. W---------------------------------------------------------- This application is made m compliance with Dunt ' p Y JOB ADDRESS AND LOCATION.._.................. .. ; ._- •�� 0- Phone-_ --------------- Owner's Name---------------- Q$-_C ------ ----{�� 4 �. -----•--------------- -----.------: , -- ---------------- Address _ �— I one -------------- Contractor's Name-------- - -- ------au --------'------- -------------------------------------------r _ __:T------------ Ph Installation will serve: Residence Apartment F ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ X--- L:3---------- 1---._ Number of bedrooms ._._ Number of baths -�_.V Lot size __.- ----------- of living units: . , Water Supply: Public system �Commun y y ❑ Private ❑ Depth to Water Table'_..-�- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [� Clay Loam ❑ ClayI'❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑/New Construction: Yes [�No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee*.]6 , (Q} Cr1 1 �•---------Material-------------------------- Liquid ---------- -- _ - Septic Tank: Distance from nearer} wa11_[��"4�--_Dista�ce from foyndatian... o � �/ No. of compartments ,Size {X S Liquid depth_- r ----------------Capacity--•-- -----� Disposal +eld: Distance from nearest well., L4^v _.Distance from foundation--�_ -----`==---Distance to nearest lot line___S_.- _ ;. .•t_ -Width of trench------I=-`/-tf-----.--- -------- Number of lines-------- .i I Length of each line ...�' _V1111 .-�_'`---_-- .- Type of fitter mate ria l---•- �----- -Depth of filter material----.I--3 '4 length----_-1.'710.`----------=---- Seepage Pit: Distance to nearest well--------------------- from foundation--------------------.Distance to nearest lot line----------__---- Number of pits-------------- ------Lining material-----------------------Size: Diameter---------------.------- Depth--------------------------------- Cesspool: Distance from nearest well__....4__.-.-!_Distance from foundation...._...-'_.....__Lining material__.-_______------------------gals.Size: Diameter------------------------ - -----------Depth------'-----------------:---- ---------------------Liquid Capacity----------------------------9 g Distance from nearest well------ .-_----------------------ti--------------Distance from nearest building------------------------------------------ Privy: + ❑ Distance to nearest lot line--- -----E -- - t r ------------------------------------------ Remodeling and/or repairing (describe}:--------------------- - ---r------------------•--- ----------------------------------------- -------------------•------ 7 -------------------------------- ------ ------- --------------------------------------------------- ----------------------------- :------------------------------------ --------------=------------------= I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i i + (Owner and/or Contractor) ------ (Signee.. --- - Own T1tla ------------- By:----------------------••------------------------ - { , (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 1 by REVIEWEDBY---------------------------------------------- -------------- DATE--------- -----------------------------------•-------------- BUILDING PERMIT ISSUED-------------------------- ---------- -� -- - DATE--------------------------------- Alterations and/or recommendations: ------- --------------• ---- --------- ---- ------------------------- --- ----- - ------ --- - -----------D- .> �c .------ - - �--- k-- ---- - ---` k�KAs-------------- ----------------------- ----------------------------------=-------------------------------------------- ------------------------------------------ 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, California Tracy, California ES-9-2M Revises 1.57 F,P.CQ.