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�¢— -2 APPLICATION FOR SANITATION PERMIT Permit No. ._?2 -3._.___. y (Complete in Duplicate) Date Issued -_ � ---- ---- Applica*ion 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�ccomplce with County Ordinance No. 549. JOB ADDRESS AND �'� f C ATION f _ ....._ .'- -F 1 -� L'/A ----- Owner's Name L!__41- ------------ -------------------------------------- Phone- ---------- Address ` `j fl.. -------- ---------------------•-------------------•-• ----------------------•-----------------_------- Contractors Name...- Installation will serve: Residence W,-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.!_- Number.of bedrooms �_. Number of baths __/._ Lot size -__-f 66 r X 2-r, .- " Water Supply: Public system I❑'_'Community system [✓`Private ❑ Depth to Water Table 4.6 ft. Character of soil to a depth of 3 feet:' Sand E] Gra vel.E] Sandy Loam ❑. Clay.Loam E] Clay 0 Adobe ❑ Hardpan ❑ Previous Application Made: Yes E] No [9--New Construction: Yes W TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ty�nk: Distance from nearest wells__'.---Distance from foundation-_..--f- Material_-__ C--_- �P�'C! Q� .r No. of compartments__-_ rrt .--O----Size._ �.v`"�3 ��_.Liquid depth__=__�y -------------Ca aci 5'�------- �- Disposal Field: Distance from nearest well- 16-O--1Distance from fou ndation-.-,vA._C>_f__:Distance to nearest lot line C) - Number of s lines__- ..it--------Len th of each ----- -- of french �-� Type or filter matei� � e ___----.t__ _a -:_ epth of filter material---- , _ _ Total --y-- ----------- length-------- See pag i : Distance to nearest well 3 d d-_1_----Distance from foundation___ ------.-----.Distance to nearest lot line-_-S-_d__� r .. Number of pits-------- material._�►/r/_C_ _Size: Diameter_--- +3..--___-.Dept h-----0�-_---_-_-----_ 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----------------------- - : Remodeling and/or repairing (describe):__._--_ _ ------------------------------------------I------------------------------------------•---•------I ---•-------•--'---•----------------------•---- --••-------------- ----------•--------•--- -------------------•---------------•-------•----=-------------------------- ---------------------------------------------------------------------------------- ------- ------ ------ ----- ---- - ----- •- •-- - - -- -----•----- -- --• ------ ------ • --- ----- 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 regulation's of the San Joaquin Local Health District. (Signed)------ ----- --�1/--------1 s .----- ------1!1-11C• ------(O ner 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------------------------ ------- ---------------------------------------------------- DATE---------- —----------------•-- REVIEWED BY----------------------------------------- ------------------------------------------------------------ �. -------------------------------------------------------------- DATE------- BUILDING PERMIT ISSUED---------------------------------- ----- ------ - - ---------------------- DATE- Alterations and/or recommendations:--_------ d �. - i _ . - _.___.. _ _ .-_ -' � � s�------------------------• -------- _ ___._.-_---»__---------------_•_----._--_-.__--_-----.____..__--..____-.--.-- ---- ---------------------------------•---------------_---------.....___._.a------------ --.._ _. ---- ---------------------•--------_- FINAL INSPECTION BY:.- ^ -----------77:---=---------=------------ Date r . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streat 300 West oafs Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES J-2M 145446 ATWOOO 12-sa