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f 1 APPLICATION FOR SANITATION PERMIT Permit No. __�L.-3------ (Complete in Duplicate) !ax ;�. Date Issued ------------_7 _--- Application 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. .r �,�.�. -�.� `.�� r � yam) JOB ADDRESS AND LO ATION = !1'n r�✓ f ----• ----------- 6 Owner's Name--- �.4.; •-------------------------------------------------------- -------------------------------------- ------ Phone - 1�_ _ --•--- Address -------------�-- 2 .3 ------------"-----------------------------------...------------------------------------------------------------------------- Contractor's NameSi 4.......I -------------------- Phone---------------------------------- . F Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ .......Number,.of bedrooms __ -_ Number of baths. _X_. Lot size --- ___________________________________ !A J Water Supply: Public system ❑ Community system ❑ Private K] Depth to Water Tablei_0___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 90 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No k] New Construction: Yes X No ❑ FHA/VA: Yes ❑ No ❑ 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___ 1_0------Distance from foundation"4_A________._.MateriaL_ ___________________________ No. of compartments-----3-----------------Size_5�kI0_A'_-----------Liquid depth__.-"I-------------------Capacity-_{_24fF--'-'------- Disposal Field: Distance from nearest well_!__- -------Distance from foundation__;-_________-__.Distance to nearest lot line--4- Number o Number'of lines------ -- -----------Length of each line-----�x�1-------------------Width of french-----'�..�------------------------ T e of filter material_ ', __Total length_ ---------------------------------- �`" Type 1 [ --Depth of_ffilter rnatenal-- - -------------- Seepage Pit: Distance to nearest well----[-�- ____-_=Distanc frorr,�„foun ation__60-_----------Distance to nearest ;of line_s_�____�__� � Number of pits.____.__._________Lining material_ -�{ Size: Diameter____.3.y Depth_.. 1__y r' - i Cesspool: Distance from nearest welL________________Distance rom foundation--------------------Lining material--------------------------------------- I ❑ Size: Diameter- --------------------------------Depth---------- 1-------------------- --------Liuid Capacity- - ---- - ----gals. a , Privy: Distance from nearest well_____________________ ________________ #......Distance from nearest building_____--.__---_-__--____-_-_-___-----___-_. ❑ Distance to nearest lot line-------------------------------- ' ; -------------------------------------------------------------------------------------------------- t I I i Remodeling and/or repairing (describe):------- ` -------- -- '--- ---------------------------------------- -------------------------------------------------------- ------------------------ ------------------ - --------- __________________________________.r____________________________ ___ _______________f________-_________________________. ____.________-----______- ____.__ ____________________________ f 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. (Signed --------------- ------------------------------------------------------------------------------------- --------------- --------(Owner and/or Contractorl I y _--'""".--(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 l APPLICATION ACCEPTED BY---- - ------------------------------------•----------------------- DATE--G-��------ r +*�9----------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ !" BUILDING PERMIT ISSUED------------- ----- ----------------------- DATE --------- ------------------------------------- Alterations and/or recommendations.-_-- ._ ...... ._ �c�.-- ,. _--- ° ..`------------------------------------- - ------ -- e-- ------------------------_--- ��f--?e----------L?-- _07 '` --- ---------------------------------------------------------------- ------------ ._. - - - - --- --- 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-9-21x1 , Revisea 1.57 F.P.CO.