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►' Permit No. Q.v....... j. �! APPLICATION FOR SANITATION PERMIT (�. C (Complete in Duplicate) �i DatenIssued Applica+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 /withh County Ordinance No. 549. JOBADDRESS )WD nLOCATION----- ......... '-----. ------------•------------------------------------------- I---------------- Owner's •------------- -Owner s Name---Ifv -----------------....------------- --- ---- - ------ - ----------- ------. Phone------------------------•--•-------- . . ----- ----------------------•-------------------------•--•------ ---------- -------------------------------------------- Address.... sContractor's Name If - ------•--------------------------------•----------------------------------------- ------------ Installation will serve: Residence Apartment House ❑ C�pmmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms0 Number of baths/---- Lot size ___ --- -- -- ____________________________ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table,�Co. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam E] Clay Loam E] Clay ❑ Adobe ardpan E] Previous Application Made: Yes ❑ No �t ew Construction: Yes 4- WO-0-TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r • Septic Tank: Distance from nearest wel --Disfance from foundation-_._l _._____.Mat ____________ __ No. of compartments------- - - ----Size__6./,- .X---D----- Liquid depth___ CapacitY_80--0- N Disposal Field: Distance from nearest well�4.---Distance from foundation____ _ _...._Distance to nearest lot line-_157/_-----. Number of lines------- ----- - -- Length of each line------_70----------------.Width of trench.•_'�___Yt."------------------ Type of filter material___ _____________Depth of filte aterial____�1 ...___._.Total length_._.__._ ___.___________.__._____.._ ar Seepage Pit: Distance to nearest wellz1 ._._Dist e from fours tion----r�__._-------Distance to nearest lot line-_�._---____- [ ..—b Number of pits------/-------------Lining mat rial. !x . .- ize: Diameter_c' --. Dept h... ---------------------- Cesspool: Distance from nearest well_______--__-.._-Dis om foundation___________________ Lining material_ ----------------- --------------__. . Size:�Riamete.r... _:. =,�_•p- �DQ,oth :_ . �_ --=Liquid�Capaci#yL - ala. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----.____-.__.-..----_____.___-.-.__-.___. ❑ Distance to nearest lot line-- ------------- - ----------------------- ------------------•-•--•------------------------------------------------------- ------------ Remodeling and/or repairing (describe)---- ----------------------------------- ----------•--•----_---- -------------------------•-------•------------------------------------------------ --------------------------------------- ----------------------••----------------------------------------------------- ------ -- - - •--- ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- P^---- ------------------------- ----------------------------------- ---------------------------------------{�/•or Contractor) BY: - - - -- --- - ---------.------------- (Title) (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 APPLICATIONACCEPTED BY..----- =��-- -----------------------==-------------------------------- DA --------------- --------------------------------------- REVIEWED BY - ----- DATE-------- -�t------•----•------•-------------------- BUILDING PERMIT ISSUED------------------------------�,-.__ DATE----------------- ---- Alterations and/or recommendations----------------------- --�_ --------------------------- ------------ ------ --S7_ -------------------------------------•-----------••----------•-----------------•------•- ---- � Y -------- --------------------------•-------------------- -}-- . - : --- = _ ---- ----------------- ---------- ----------------------- --------------------- FINALINSPECTION 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 145445 ATWOnO 12-54 - L