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APPLICATION FOR SANITATION PERMIT Permit No. a-_---.-.r------ f (Complete in Duplicate) Date Issued Applicafion 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. �/ ; f sa _ C"{2_-0 g 4Nsl�_1 JOB ADDRESS AND LOCATION_a`�dQ?____ t-Ei� 5�1_ Gb h'IQA_I-- t- '-----�51Y��4L __l_l eW----- Y 1 --- f Owner's Name---- 1 lY--------------------------------------=--------------------- _:Z --------- Phone_ _- i . -- _� .c__- I { -- -------------•--------------------------------------------------- Address-- ---------=------------------ "- -- 19 - ---------------- Phone---- ��11 Contractor's Name.-_ �_ ----------- � - f , . Installation will serve: Residence JK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of living units:6yLk Number of bedrooms!lvo_ Number of baths _ ----- Lot size---&d/x--1 - --------------------------- j Water Supply: Public system [0 Community system ❑ Private ❑ Depth to Wafer Table 4-�9_ ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe.In Hardpan ❑ k Previous Application Made: Yes ❑ No (1 New Construction: Yes D4 No ❑ (" TYPE.OF,.INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p T Septic Tank: Distance from nearest well-- -----Distance from foundation_-'/4�.. Material--- -e e�';l .3 . _�-_ Li uid de th_ c '.__- Ca aci+ r�GO No. of compartments______'---- 0---------Siz _ _ . - '- q p p Y,-- ------- ' 6 fi�-_______Distance to nearest lot line____--_____- Disposal Fiekcl: Distance from nearest w - Distance from oun ation__' __ ___ �� Number of lines----- _ __ -------------- -Length of each line--- 1 --------------Width of french---- ----------------__---- Type of filter material__ _�Gt1.'�____Depth of filter material--- _-_---------Total length___.��-,5______________ f �i Z. Seepage Pit: Distance to nearest well---- __-------Distance from f undation.� _________.Distance to nearest lot.line-:_____________ I Number of --------Lining materia►__ t----Size: Diameter__ ______________Depth__ _ _-___--___________ 's € Cesspool:- Distance from nearest well-_____.________Distance from foundation------------------- Lining material------------------------------------ ❑ Size: Diameter-------------------------------------Depth-:----------------------------------------.------ Liquid Capacity gals Privy: Distance from nearest well------ _----------------------------------------Distance from nearest building__________----_-________.____--_-.------- t ❑ Distance to nearest lot line--------- = ----------------------------------------------- --------------------- r Remodeling and/or repairing (describe):-----f-I!-�XA/ ..-------- - ------------- -------------------------------------------------------------- -------------•-----------------------------------------------, ---------------------------------------------------------------------------------------------------------------- ------------------- --------- I hereby certify that I have prepar d this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, and rules and re ulations �oflSan Joaquin Lb a] Health District. !� 4 ------ By:. f - G E ! (Owner`and/or Contractor) (Signed)- -- ''` ^'4'!' ---------------------------------(Title)-----1-- --- -------- - By---------------------- - I - --- (Plot plan, showing size of lot, location of system in r lation to wells, buildings, etc., can be plac d on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------- °------------------------------------------------------------------------------- ---------------- DATE--- --------------------------------------------- , REVIEWED BY--------------------------------- ---/----- -------- ------------------------------------ - ------------------- ------- DATE---- -- - " BUILDING PERMIT ISSUED----------------------- ----------------------------------------------------------------------------- -DATE----------- ----- -------------------------------- ---- - - - - -- ---- ------------------ Alterations and/or recommend afions--------- ------------------------------ ------ -------------------------- ---- ----------i-----•-------------- -------------------------- ------------ -------------------- ------ ------ ---------- --- -- ----- ------ ------------ ----- ---------- ----------------------------- LL ---- --------- -------------------- -- ------ ---- -- - -- FINAL INSPECTION BY:----- -------- -------------- - ---------- ------- — - ..-- fe --- ------------------------------------------------------------------- SAN JOAQ UIN 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 LS-9-2M B-51 Revised W-2100