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" APPLICATION FOR SANITATION PERMIT Permit No. __!.a_�s--____ * �1k� (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. pp with County Ordinance No. 549. This application is made m com {lance w . -------------------------------- ------------------------•----------• ----------------------- - - - .. . . p z . iL JOS ADDRESS AND LOCATIO a --_/'7- - 117 - tn1JC, ---------------------- -------- - Owner s NameKaA Phone � �J�3 ---••-- -- A- ----------------------------- AddressE/ � ---- -------- -------- ------ A_ ------------ -----'-' t" �— Jas----- Phone Contractor's Name---- ------------------- -- ----------------------------- -------------- ------------ -- ---------- Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _2'__ Number of bedrooms ________ Number of baths _.__ Lot size --------_------_------------------------------------- ---- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobe)d Hardpan ❑ Previous Application Made: Yes ❑ No'14 New:Constructon: Yes)< No ❑ PHA/VA: Yes ❑ Nox TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.)„. Septic Tank: Distance from nearest well,'-_Distance from foundation-___/'D---__--_-..Material_________ _ _ ____ ____-____ No. of compartments p ---------Size-------------------- ---- _ C------------ Capacity------- �Q ' t __.Distance to earest lot;ine__..S_____-___ Disposal Field: Distance from nearest we!I` -_.__Distance from.f.oundation__�_�_______-_ Number of lines-----j------,-�- �-- --' Length of each line-----'---0--------------- Width of trench--- - ------------------------- Type of filter materiai---- T-T_ ��_____ Depth of filter material__-__2Y---.__.__-Total length-_-.__ I?�_--------------------------- f Seepage Pit: Distance to nearest weli__C7L4nf-------Distance from foundation_,V.k------Distance to nearest lot hng,_'S�.____� f Number of pits-----I---------------Lining material-- Size: Diameter---- 3____._______,�Depth___'�' '�" -------- Cesspool: Distance from nearest well-----------------Distance from foundation-----------_--------Lining ma.terial---------.________._-_----._______- r ❑ Size: Diameter------------------------- ------------Depth------------------------- -------Liquid Capacity-.--------------------------gals. { Privy: Distance from nearest well----------=-------------------------------------Distance from nearest building------------------------------.---------- ❑ - Distance to nearest lot line------------------------ -•--------------------------------------------------------------------------- Remodeling and/or repairing (describe)--------------------------- ------------------------------ ----------------------------------------------------------------••----- ---------------------------------------------------------------------------- .<- ----------------------------------- ------------------------------------ ------------------------------------- ----------------!-•------------- ; application and the work will be'done'in accordance with San Joaquin County I hereby certify that I have prepared this ordinances, Slaws, and rules'and re Mations of the San Joaquin Local Health District. { 4 (Signed ----_ ________________________________(Owner and/or Contractor) ] 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 APPLICATION ACCEPTED BY_._ _.___ __ DATE_______ _____ ____ - _I S- -------- ---- ---- ---------------------------------------------- REVII WED BY ---- DATE ----------------------- --------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------- ------------ DATE------------------------------------------------------•----- Alterationsand/gr recommendations:---------------------------------- ---f------------------------------------------------ ---------•---------------------------------------------------•------- -' -•---------------------- �---------x'17-'---------.�_�_ -- --�------- ��-r --------------- ---------•---•--------- ---------- ----------------------•---------------------•-------------------------------'�-------------------------------------------------- -&I FINALINSPECTION BY----------- ---------•------------------------------------------ Date'.�j_-fZ-.-- ------------------------------ 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-4-2M , Revisea 1.57 F.P.CO. Iry