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FOR OFFICE USE: ------------------------------------------------------ p� APPLICATION FOR SANITATION PERMIT Permit No. ../s.......�.a ------ (Complete in Duplicate) --- ------ This Permit Expires ] Year From Date Issued Date issued __ Application is hereby made to the San Joaquin Local Health District for a permit to con trust and install the work herein described. This application is made in compliance with County Ordinance No. 5497 )e5+ p J JOB ADDRESS AND LOCATIO s r ------IDL&N�c �---- L�Ch,+ :� �' � ' e. 4_.L�Lride ti....--RA.�L ��Pn ........ Owner's Name-------------- I-,•Cu ---••-- ----------------------------------------------- Phone-- Address. _a.5.05 AD--------------•---•-------•--•----......................................................................... r Contractor's Name............�.'�? ��!` l�{ ................................_...-------------------------- -•------•--•-- Phone----------------___.............. Installation will serve: Residence 1K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other C]Number of living units: .1----- Number of bedrooms _ Number of baths S-- Lot size .....+�-{�---a-C re. ----- Water Supply: Public system ❑ Community system ❑ Privatev Depth to Water Table.-_-__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) NDIX New Construction: Yes,,g No ❑ FHA/VA: Yes ❑ NoJR�' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cess ool permitted if public sewer is available within 200 feet.) iR L St J Septic Tank: Distance r nares# w 1L �'. i[ll,Dis}ante from foundation-�p- d _F.Ma+e 1�1.._---� $- ..... .•....____.•__••. No. of com artments.---- -Size___ ... P fi5 Liquid depth Capacity----$ey.pa I Disposal Field: Distance from nearest well-155-------Distance from foundation./GC,(il[E1-!---Distance to nearest l5t line..5 ....... Number of lines---------- Length of each line------13_67!...........Width of trench n Type of filter material,s.i4i....Depth of filter material-------1.9__r-_e-_-_--Total length........ -15..--_________________ 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,----------------------------------------- 0 Distance to nearest lot line Remodeling and/or repairing (de tribe .�!PCt - t'/ — - . {'� xx c�r�. o -`�- ': ~ _-> T� -�•--------------------------------------------------------------------- - -----------------------------------------•--------------------------------------------------------------------------•----•-----------------------------•-......................................................... I hereby certify that I have prepared this application an that the work will be done in accordance with San Joaquin County ordinances, State I s, nd rules and regulations of the S n J quin Local Health District. (Signed)--......--•. .... --J--------------------•--•-----•---------------------..--..._..----(Owner and/or Contractor) By---------------------------•.............-------------- -------------------------------------------------------------------------(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---------------------------- ------------------------------------------------- REVIEWED -----------------------------------------------REVIEWED BY------------------------------------------------------------------------------------------------------------------------------ DATE---------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------—-------------------------------------- DATE----------•----•--- Alterationsd res do •--- - ---- --- --- ----- - FINAL INSPECTION BY-------------------------- ---------------- •--•---------------- Date----------------------- ... - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,Callfornia Manteca,California Tracy,California E8 9 REVISED 8-$9 =tit 5•8t ATLAS