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P� .7 ,� .1�,5 � APPLICATION FOR SANITATION PERMIT Permit No -- --J~�- �p (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. This application is made in compliance with County Ordinance No. 549. I Q' ,r} JOB ADDRESS AND LOCATION---------F�---- 0-----150----------- -a-V I-D-------- ------------------------------^ / Owner's Name--------;---L'=-•T1-_AIIE---------�Q_�_��-----------------------/--------`--------------------------------- Phone__^��---------- Address.. .7-/K__-[------------------------------------------------------------------•----------- j� - I �-1,� Phone---- - 7� oa- Contractor's Name:----- `-------- --A--- --------�-,WSJ Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court [_1 Motel ❑ Other ❑ 5�- � 1 `C? ----------------- Number of living units: l��-°.Number of bedrooms �.�_ Number of baths _-f___._ Lot size __ti _ ------ � Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ElClay ❑ Adobe[ Hardpan E] Previous Application Made: Yes ❑ No New Construction: Yes ❑ No A 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____---_________. ty ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Caaci Disposal Field: Distance from nearest well__ S`____.Distance from foundation____�f__`______Distance to nearest lot line___----------- Number of lines---Q ------------ : 0-Me of each line------ ---- Width of trench__ �-_-__-------______-- -_- 3 Type of filter material_/_�; Depth of filter material-__l2 _ __ _____________Total len th____ _ _- ____________________._____ Seepage Pit: Distance to nearest well-------------------------Distance from foundation--------------------Distance to nearest lot line______________.__ ❑ , Number of pits---------------------Lining material---------------------- Size: Diameter------------------------Depth--------------------------------- 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----------------------------.------------- ❑ Distance to nearest lot line-------------------------- ------------------;--------------------------------------------------------------------------------------- Remodelin and or repairing (describe): r 9 / P 9 ) �—� - . ------ --- - � ------------ --------4�-.1_�s_ .1 - ----- ------------ -----------------------------------------------------------•----.------------------------------ ----------------------------- I R 1 hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, St 4 ws, and rules" and re ati ns of the San Joaquip4cal Health District. k I S _� �-_-,.-- � s -__(Owner and/or Contractor) {Signed) •----�- 1 � - I ,s� F Title----- -------------- {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plac�eld on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY__ - __. .i___ _ _ - _ DATE = REVIEWEDBY--------------------------------------------------------------------------- ----------------------------------------k-------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------- --------------------------------•-- DATE---------- - --------------------------------------------- Alterations and/or recommendations:--------------- -----•---------------------------------------------------------------------------------------------------------------------- r --------------- ------------------------------------------------------------------------------------ ------------------------------------------- ------------------------------------------ --------- ------------------------ --------------------------------- --------------- ---------------------- - ----- --- ------. ...... FINAL INSPECTION BY: ---- Date _ -- --•- ----"=--- I SAN JOAQUIN LOCAL HEALTH DISTRICT x 130 South American Street 300 West Oak Street 132 Sycamore Stree4 814 North "C" Sfireet Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M B-51 kevised W-2100