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1 o�ry Permit "No.APPLICATION FOR SANITATION PERMIT o. _; r]4i {Complete in Duplicate) Date Issued ------- -�-�-��y Applicafion is he�eby�made to the San Joaquin Local Health District for a permit to construct and install the work herein descrii ed. This application i made in compliance with County Ordinance No. 549: s ��@ jf 's JOB ADDRESS AND LOCA ON----'CA_ --------A------ ---��`�_�rt- ------��_al_ ---- --�-�-•s_�_.-- --fY�G Owner's Name ! ice-r------ tel ---- --------- I----------------------------------•------------------------- Phone-----------------------------'------ ✓fll -----------------------------------------•-•------------------•--------------•-------------- Address....-----------------------•------------- ------- 1 Contractor's Name--------------------------------------------------------------------------------------------------------------------------------------------- Phone-----------•---------------------- Installation will serve: Residence �M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i� Number of living units: __I___ Number of bedrooms J_____ Number of baths ___/__ Lot size ---•------------ i Water Supply: Public system © Community system ❑ Private .❑ Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam eo lay Loam E] Clay El Adobe 10 Hardpan ❑ Previous Application Made: Yes E] No dew Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic'sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ ,g --Distance from foundation_-_.id-__-____-Matfigl____ ____ -A _. ____-_. No. of compartments--------____Z�-______Size______�vv-6x ___Liquid depth_____________�—______Capacity___�d` —� Disposal Field: Distance from nearest well_._ ---------Distance from foundation---;V --------Distance to nearest lot I'sne__��________- Number of lines__________�'l __: Length of each line___-____447-1__---____.Width of trench-------2!_G__--_---_________ Type of filter material----S--_ --Depth of filter material_____-/•7-__----_Total length _________ �r p_________________-__ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________________ ❑ Number of pits----------------------Lining material---------_-------------Sze: 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-----_--------------_--------------------. G y ❑ Distance to nearest lot line----------------------------------------------- ------------------------------------------------------------•--------------------------------- Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- i --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby cert' y +hat ve prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, S+ ws „ter iesa- ?regulafjons of +he San Joaquin Local Health District. (Signed)--- - ---- - - ------------ - ----- ------ - -----------------------------------------------------------------------------------------{Owner and/or Contractor) By:----------------------- - ----------------- -----------------------------------------------------------------------------(Title)-------------------------------------------------------------= (Plot plan, showing siz of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FO. D �TMENJUSE ON Y APPLICATION ACCEPTED BY------ .---- ---`---- - ---c --- -------- ATE jC --------------- REVIEWEDBY--------------------------------------------------- ------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or, recommendations:---- --------x----- _ " ---n--_---- ------ ---------- ------------ - - -- - -------------9---------------------- ----------------------------------------------------------------------------------- ------------------------------------------------------ ---------------------------------------------------------------------- -------------------------------- -------------------------------------------------------------- - --------------------------------------- -------------------- --------------------------------------- ?i �---------------------------------- FINAL INSPECTION BY------------- :----------------------------------------- Date------ 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 8-51 Revised W-2100