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FOR OFF1C = / ,d .� /.--�:--- -----+-- - Permit No. ._.---- -••-.-••- �, APPLICATION FOR SANITATION PERMIT - - ---------------------------------- -- (Complete in Duplicate) Date issued --_- k-''--••- _ --------------- This Permit Ex ices 1 Year Fram 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 Ordinan No. 549. --•--_--_--- .......--•---_--- -- JOB ADDRESS A LOCATION /.. �-••----- Phone.......__--------•-- .._ --------------•- •--------------•---------- Owner's Name •--. . -- -- •--- ... ------------- _- --------- Address------------- --------- ------ on . -- e 4-- Contractor's Name--- s�J . j� -. Ph �--•lam --------------------•-------• Other ❑ Commercial ❑ Trailer Court ❑ Motel ❑ � Installation will serve: . Residence B—APa ment House ❑ , -- �J i Number of living units: �--- or of bedrooms 1�Number of baths --- Lot size ..�v-r---• ........ Depth To Water Table6.q q #t. Water Supply: Public system Community system ❑ Private ❑ Dep a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ NColay ❑FH NA Yes ❑rd No ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Ye ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' ilable within 200 feet.) (No septic tank or cesspool permitted if public sewer is ava t .----•---.Material ------•---•------•- IS- -.------ 1 Septic Tank: Distance from nearest weH_ - tk_Distance from foundation__, ply P. No. of compartments .___ ..____Sixe�`��.3_�'-•-----Liquid de th_ __ P-t_..--------Capacity----- .. ..--- [ � r! �' --.Distance to nearest lot line._ •--�05 eea Distance from near well_Np s n e rom ou da _ `� Number of lines--_- -_- ------•--------•-•-'Length of each line/ ----- of trench_-�t'_�_�!_---• Q� De th of filter material----,lg-��-----Total length-_.-------'�`p------ ----------- ( ~� " Type of filter material�r--- --__---_ P S page P#:`' Distance to nearest well-------- --Distance from foundation--------------------Distance to nearest lot line-------.---.----- Number of pi#s-----------•---------�Lining material-----•--•-------- -----Size: Diameter--------•----- --------Depth----•----•----•---•-------••---.. i J Cesspool: Distance from nearest well-----------------Distance from foundation.--.---------------Lining materialy----_-_-.-_--_-------------gals. - - .Depth--------------- - ------------------------Liquid Capauty---•-------••---------------9 ❑ Size: Diameter--F-----•------------------ -------- Distance from nearest well----------------•'ice- ----------- ---_-------Distance from nearest building------------•--------------•------------- IPrivy: ----------------------------------------------------- r ❑ rr Distance to nearest of line ---'�-------=- -- --- ��.._•� -__. -----•----•------•----'---- I ----- ------„1 eling and/or repairing (describe): = --- .__ --- - --- emo ---- --- ---------- --------------------- -•le•--------- i ------ -------------------•---•---•---•----- -•---------------------------•------------•--- hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinance , S s, and .ules and regulations of the San Joaquin Local Health District. t (�.� Contractor) c UCJ -------------------•-- ��or f (Signe !�-' f _ /---- or (Title)--------•------------------------------"- -------- ----------- 1 • -- By:------------------------------------------ -------------------------------- (Plot plan, showing size of lot, location of system in relat' to wells, build' s, a+c., can be placed an reverse.si e. FOR DEPARTMENT USE ONLY -------------------- APPLICATION ACCEPTED BY ---•- - ------ ------ ----- --------------- --- DATE----� �: �= = REVIEWED BY .-....- DATE----------------•------- DATE------- --------------------------•-------------.._------- ------------- BUILDING PERMIT ISSUED----------------------------------------- --- e_�� --►- ----- , Alterations and/or recommendations:.-�S ( - - ``-------1 �- i 'n _ ---.------•- tti K. ][�.C� ----•--•---•----- �t - ------'-.�a..--- - -------------- ---------- - ---- . ------------- --------------------- ------------ r ------------ FINAL INSPECTION SY----------- --- -- -- ------------- Date- --------------------------------- FINAL JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California ES 9 REVISED a-59 21A 5-62 ATLAS