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APPLICATION FOR SANITATION PERMIT Permit No. .(Complete in Duplicate) �o z Date issued 45' 6-f-etjxy Fr 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. JOB ADDRESS AND LOCATION"""" 3---- • .. ` "Ct1ff�,, Owner's Name------------ = ePhone 1�G1 f TM Address---------------------------.......�',. � .,�n -�!� � � I Contractor's Name---- --- ----- - �`-'�-rY-'``�j�' -- ------- ` --- ------ Phone----•------------------------------ Installation will serve: Residence C, Apartment House ❑ ;GomMercial ❑ Trailer Court ❑ M tel ❑ Oth r ❑ Number of living units: _-_�_ Number of bedrooms _� NNber of baths _/----- Lot size ---------- ------ ---- ----- ft. --- Water Supply: Public system ❑ Community system ❑ Private,< Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E❑ Sandy LoarnA Clay Loam El Clay El Adobe❑ Hardpan ❑ Previous Application Made: Yes No ❑ New Constructioes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: d' -/k-*.�. (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---- -_ lfoundation_ q p i .�.OY'~G No. of tom artments +� - ------- Size !! p p DistancreLiuid de th---Mat real---------Capacity---- �a-------- A . Disposal Field: Distance from nearest well "".."Distance from foundation_--- lQ""""---.Distanco to nearest lot line"-- 5 --- Number of lines--------I&L--------------------Length of each line---------490Width of trench.--__"./ _ ��___- ------ . Type of filter mate rial-I1.Q3z.______Depth of filter material__.""_" -""-----Total length-__---_---l2.r!------------------- Seepage Pit: Distance to nearest well----"-----------------Distance from foundation"--.-----_-__-_--Distance�o 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 v✓eIL------------------------------ ----------------Distance from nearest building------------------------------------- - I ❑ Distance to nearest lot line--- --------------------------------------------------------=-------------------------------------- -------------------------------- -- Remodelingand/or repairing (describe)------------------------ ------------------------------------------------------------------------------------------------------------------------------- ------------------•-------------------------------------------•------------------------------------------------------------------------------•------------------------------------------------------------------ --------------------------•---"-------------------------------------•----------------------------------------------------•----------------------------- ------------------------------••---------------------------------- -------------- r I hereby'certify that I have repared this application and that-the thework will be done in accordance with San Joaquin County ordinance, Sta+e aws, d r 1 rid regula ' sof the San Joaquin`Lacel Health District. (Signed) -- ------- ------------------ --------------- --------------------------------- --------(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 a r APPLICATION ACCEPTED BY--------------------- ------ - ,-_- _ - -- DATE------ REVIEWED BY--------------'------------ ---------- ------- ----x ------------- DATE --= ------------------ B�U/�LDII PERMIT ISSUED-----•---------------------------------------------------------------------------- DATE c�G'JBf afi?Sns and/or recommendations:------------------- V�e U- _ _ _. . --------------- -•-_-....-"-------- ?c'_-64G_ - -" ---" .�- G`' � �4 -------------- ..... FINAL INSPECTION BY:.----"- Date.-�5� c/7 ��- ----------------------------------------------- -- - -- - --------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revised 1.57 F.P,CO. y