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II APPLICATION FOR SANITATION PERMIT Permit No. ,2�7 q (Complete in Duplicate) 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 compliant it County Ordinance No. 549. JOB ADDRESS D Li�OCf�T: 1__�r= t -- -------- -- ------------- Owner's Name- Phoneme Address I ..------------------------------------' - -- ----------• •-----------•---------•----------------•--•---------••------ --------------•--•--- -------- Contractor's Name-- - ----•----• ------------------- one ------------------------------------------ Ph , Installa+ion will serve: Residence A partmen I House ❑ Commercial ❑ Trailer Court _Motel Other ❑ 1 ❑ 1 ❑ I Number of living units: ___�. umber of bedrooms --- --- Number of baths __/-___ Lot size x ----------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ___.--__ ft. Character of soil to a depth of 3 feet: Sand ❑ I Gravel ❑ Sandy Loam Q, Clay Loam E-1Clay ❑ Adobe Hardpan E]Previous Application Made: Yes E] No LR New Construction: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted iAzx Ler is available within 204 fee}.} Septic nk: Distance from nearest well---- l_ /Q ristapc¢ fr r foundation__------ ateria_y______________ ___________ _••__------- No. 1 No. of compartments----- ff..... l Siz -_C�_-��- ----Liquid �epth------------'T---------Capacity---- -Q- ) Disposal'Field: Distance from nearest weWl4j�Distance from foundation/ __. istance to nearest Lot Ii e---------------- Number" .,-5- J w`l" �) dumber of lines-----------<,f________________ Length of each line----- --_PWidth of trench.___ __.-_, // ---------- Type of filter materiel_ _ _ _; C% �?epth of filter material------- length-------- - ------------------------ Seepage Pit: Disfar;e to nearest well---__.__-------------Distance from foundation------.-------------Distance to nearest lot line-----..-_____..._ ❑ Number of pits----------------------Liming material------------------- -Size: Diameter-----------------------Depth-_--------------------- ---------- Cesspool: Distance from nearest well----#--------._Distance from foundation--------------------Lining material-_---___.-----______._ ------------------------------ ------ 1-1 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)---------------------------------------------------•--------------- -------------------- - ------------------- 111 ------------------•--------------------------------------------------------•----------------------•--------..-..----------•---------- ---------•------------------------------------- --------------------------------------- . ----------------------------------------- •- I hereby certify tha I have prepared is appligation and that the work will be done in accordance with San Joaquin County ordinances, la e lu and.r . . ations f the San Joaquin Local Health District. (Signed ..-. --------- --•-- --------- ----- - -----'IN---------------- ----------------------------------------------------------- (Owner and/or Contractor) --------------------------------------------------------------- --- ------------------------------------------------------------- Tale -------------------------------------- ---_ ----------- ------ (Pat plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------------•--- DATE REVIEWED BY �j 4��.- --- -------- ------=------ - ---------------------------------- DATE---_{�.._..---------------------------------••------------ BUILDING PERMIT ISSUED-------------- _uu DATE ------------------------- Alterations and/or recommendations-------------•---------Ip--- ------------------------•------------ -•-----------------------------------------------•------------- ------------ ----- -------------------------- -- - --------- ---------------------------- --------------•--------- ----i I -------------------------------------------- --- ------- ------------------------------------- FINAL INSPECTION BY:..- - ---------==----------------------- Date------ ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West OalIk Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteea, California Tracy, California ; I ES-9-2M 10-52 Revised W-2100