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APPOCATION 'FOR SANITATION PERMIT Permit b� +C i (Complete in Duplicate) �`�i ! v�'' Date Issued __.....�--_.� Applica4,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 Ordinance No. 549. ' / ----- --- JOB ADDRESS AND LOCAT.QN-----1---�"hS--'-�-�Re ------ -- ------------------ --- --------------------------------•--------------------------------------/� Owner s Name / �? Phone_f t ----------- ------�C,�'YL�C? 170 Address. 1 ' '-- ------------- -•---- -------------------••------------------------------------------------------------_.----- Contractor's Name--- ..-------------------------------------------------------------------------- --•----=--------------------------•-------- Phone-------------- .._.. Installation will serve: .Residence Er'Apartment,House:,❑ - Commercial-[-] Trailer pdcurt ❑ Motel ❑ Other-El Number of living units: _!�____ ber of bedrooms .�._ Number of aths /_____ Lot size ----_��___� ��_._"-__ ------------------ Water ____-_______-_ Water Supply: Public system Community system ❑ Private Depth to Water Table-17-__"j,4' ft. ` Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ElAdobe Hardpan ❑ r Previous Application Made: Yes ❑ No New Construction: Yes 2--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic lank: Distance from nearest we11 _�__.___Distancefrom fo ndation___lf1"`--____-. aerial___ _ _ ___:_._. No. of compartments_.._.__ _.___-_______-Size__ ___ ._ _ _ Liquid depth._ f ---- __.Capacity__ O ^r Dispos Field: Distance from nearest well-. _` .___Distance from foundation._Lb__'_____'.Distance to nearest lot line-_0-------- Number of lines____________________"-_ -Length of each line_ _.ib_`_ _ _ Width of trench_._�i-�l_-__________._______. X Type of filter material-- __-Depth of filter material---/.?-------------- _Total length____ G _________________-__.- Y Seepage Pit: Distance to-nearest well----------------------Distance from foundation---------------------Distance to nearest lot line----------------- ❑ Number of pits------- --------------Lining material_--------------------Size: Diameter-------------------- Depth_-------------------- ------------ Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material_____.______--__---.__________.______ . 1 ❑._ Size: Diameter r.-`--------------=--+.-fi-r-_-----�------.a-:-e-�-.-.D»e-p_.�th.-r-�--------u----_-- �-4- --f �•�':�.�°"-�-.-..y a_L-Liquid Capacity- a aci -�----,.-r-,-.--- -------- ----- ga Privy: Distance from nearest well_ ---------------------------------------------Distance from nearest building------------------------------------------ El _- ----------------•-•--------❑ ls - Distance to nearest lot line___________ ________________ `"' I � - i Remodeling and/or repairing describe):_______________________ f -----•------------------------------------------------------------- -•-----------------------•-----------•----•----------------- ' ------------------•------------------------------------------------'-----------------•-------------•--------------------•--•- ---------------------------------------•----•-----------..._•_-•-----------------------•------- "' , -----------------------------------------------------------------------------------------•---------------------------------------•---•-•----•---------------------------------------------------------- ---------- I hereby certify that I have prepared thi plication and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regu io s of the San Joaquin Local Health District. (Signed)-_. ...- -- -----�----------� -------------�. salc�c --------------- --.{Owner and/or�Contractor) _r . Title (Plot plan, showing size of lot, location of system in-relation toells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -------------- ------- ------------------- ----------------- DATE ------------- -------� �. ... REVIEWED BY----- =`=J - --------------_--- -- DATE BUILDINGPERMIT ISSUED-------------- --=-•' DATE---------- ----- ------------------------------•------------- Alterations and/or recommendations:___________________________ - �" = =- - -•---•-----------------------------------•--• - ------------------------------------------- --------------------------------------- - f+ mow• - Y5�• __________________________"_. ______ .______-----------------7 ----------- ---- ------ ------- .......;A ----- _________________ -._..__--__._.___ - , -------------- FINAL INSPECTION BY=----------------- -- --- + ----- - - + -------•---------------- Date_..._ '�-----r-� --------- -• • ----------------- 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 W-2100