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- Permit No. ____��-�-- -.-- APPLICATION FOR SANITATION PERMIT } (Complete in Duplicate) - Date Issued ..�/!- �. ---- - � I Applica;ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h reinGd_eescribed. This application is-made.in compliance.with County Ordinance No. 549. �`� 2 -P 1. . . o G.t f t tic W : 4---��---- ------------------------- -A ` JOB ADDRESS A LOC T10 .._ --�-�- �----- ------- ---- - -- -- F G -------- ----------� Phone--.------ ----------------------- Owner s Name.--- ---r-� -• ---••------ ----------------- It _ r ------ Address-....-- - ---- ---------••----------------------•---•-----•---------------------------------;---------•-•---------•------ %�--fes Phone Contractor's Name--- = ak Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court e otel ❑ ther ❑ Number of living units:-- ---- Number of bedrooms .. Number of baths _ _---_ o size _---------------------------- K--------------------------- Water Supply: 'Pubiic system ❑ :Community system ❑ Private Depth t Water Table __5__ ft. Character of soil to a depth of 3 feet-. I et: Sand ❑ Gravel-[] Sandy Loam ❑ Clay Loam Clay Q Adobe Hardpan E] Previous Application Made: Yes E] NoNew Construction: Yes ❑ No 4! TYPE OF INSTALLATION AND SPECIFICATIONS: kto �(No septic tank or cess ao�permitted if public sewer is available within 200 feet.) tk: istance•from nearest well__;'.........:.:.Distance-fromfoundation_--- .---• Material-.------.._._--.-------.--_---___---.-_-_--___ No. of compartments----------- -- Liquid de 'th--------------_--.-- ----Capacity E? p Y Di s osal Field: Distance from nearest well..----D'stance from foundation_--- - - Distance to nearest kg$.l�n a C7:G 1j�—�-- Len Length of each line_ �- / plidth of trench------- - ----- -------- Number of lines----•--/------ g t - ; Type of filter`material:�� Depth of filter material--_-�-- ------------Total length---------- - ----- 7 Seepage Pit: Distance to nearest welly'------------------'-Dsstance from foundation ..----.v:-....Distance to nearest lot Imo---------_-.__._. F -------Depth.- ------------- i ❑ Size: Diameter__.----•----_--- Number of pits------ ---------------Lining material---------------_ -- -- f Cesspool- Distance fro Ii nearest-well--_-_--.---..._-Distance from foundation__..-._._... :.Lining material-----..---------------_--------._---_. 'l - Depth= _Liquid Capacity Size: Diameter------------------ 0 - ---- -' --Distance from-nearest building - Distance from nearest well .----- � 0 Privy: - ------------ ❑ Distance to'rearest lot line-."` F -- :': I%--,-.rJ �`; 'ice"/�rye� ---•------••------•------ P 'i �� - C--- --------i - ------- Remodeling and/or repairing (describe)--- ---- -------------cg;'i �' == -- . -- •---- -r`'i'� ------------------------------------- IM t -----•--------'-------------'------------••---'--------- -•--.------••-•---------------- --- 3 s J -X"f 1 -3--�-- --------------------------•--------------_.' I hereby certify that I have l'iprepared this application and.that the work will be done'in accordance with San Joaquin County ordinances, State laws, an rules),and regulations of the San Joaquin Local Health District. -c --------_ - ------(Owner and/or Contractor) (Signed)---- ---- - -- --`--•----------!--1---�--- - - ----- ------ -------•--- ----- ------ ------------ - , By:.................... �I`-----------------------------------------------` --•-(Title] (Plot plan, showing size of lot location of�system in rola+ion to wells, buildings, etc., can be' placed on reverse side). 4. FOR DEPARTMENT USE ONLY 1. i ----------.- DATE----------------•--- --- -•------------------------------- APPLICATION ACCEPTED BY----•--------------------------- - ---- DATE--------f_t._ (- REVIEWED BY.----- -- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------- I-------- ----------------- e - --- - -- -. . Alterations and/or recommendations: -------------------- -----•---•-------------... I ------------- ------------1--------------------------------------------------------------------------- 6- --------------------------------------------------- ---------- JP A A) - i. --_-•�-----------�-�--_---- ' z -------------------------------- -- -•- _•-•• _•---••--•• ---• --------..-.-.-.--...----•_._••-- ••-•--------------------------------- ------------- _•-- -•- _7_ ------- - Date------------------ �---w ------------ ------------- FINAL INSPECTION -BY:-"---- ------------ ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street' Trot California Stockton, California - Lodi, California Manteca, California y. ES-9-2M 145446 ATWOOO 12.54