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APPLICATION FOR SANITATION PERMIT Permit No. ---___•-___---- � (Complete in Duplicate) Date issued J _ __I__-!_ Applica-1-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 compliance with County Ordinance No. 549. A4-0 _ (cErp 17 6tFr_L W E WJE Tk s 7' ' -, r-LSC'---�--�-------------•--------- JOB ADDRESS A LOCATION_// ''-------�8- --------� C ` Owner's Name__ ___ s Phone---------------------•------------- _ ----------- .�Y.Cr' _ Address----------- ------,e T ,E1 /¢ '-------f--A0-�-C ------------------------------------------------------ �`.....-.. Contractor's Name-----fixe ��H -°•-------------------------- --------------------- ---------- ----------•----- Phonee ----4 c 1 Q-7- Installation will serve: Residence ❑ Apartment House ❑ Commercial [E—Trailer Court ❑ Motel ❑ Other ❑ 10, Number of living units: -------- Number of bedrooms -------- Number of baths _ Lot size ---L4*!_4�---- __ .. -0---------------- Water Supply: Public system ❑ Community system ❑ Private p13epth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No T- New Construction: Yes [ o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) fi � ' - �� ance from foundation_ . aMaterial._._ __ _---�`'`- - - - ` Septic nk: Distance from nearest well--.7 --� - DistR.1 � q �- ents---------� p _ __6 --- ---------Capacity.�e---_ No. of compartm e 10 Disposal Field: Distance from nearest well._ ___-_Distance from foundation____ v_.___.Distance to nearest lot line-_ �______. Number of lines-------------Z j�- _ ._Length of each line--_._ d�---------- .Width of trench------ material._-_/.. __. _ '--Depth of filter material....__J_ __,__..Total length_____----- Type of filter P- ------------------- Seepage Pit: Distance to nearest well..........____.-I---.Distance from foundation------.------:......Distance to nearest lot line__.__._-__-_-____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------------.-Depth--------------------------------- Cesspool: Distance from nearest well------------------Distance from foundation ------------- material______________________________________ ❑ 4Size: Diameter--------------------- ------------- Depth_.__. -------==------------------------------------Liquid Capacity------------------------- gals. ' � ---- - .- j � Privy: .� Distance from nearest well-------------------------------------------------Distance from nearest building-- _._______.________._ - , ❑ Distance to nearest lot line---- ------- --------•------------------------------------------------------ --------" Remodeling and/or repairing (describe): ..... �'-� / s 3'7`e lit--•-------_----------••-•---------•--------•-------------•--------------------------------- ------•--------------------------------------- ------------------------••------------------------ ------------------------------------------------------------------------------------•-------•------------------------------------- -----------•----------------------------------------•---------------------------------- moi' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a laws, and rules and regulations of the San Joaquin Local Health District. Si ned /� /'I ./�C r ------------ ------------ ----------------------- Io rand/or Contractor] Y� ----- ---------•--------(Title)------9;� 1--------------------- ---------------- ---- -------------- B r� + -- �y (Plot plan, showing size of lot, location of sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -------------------------------- -- ---=--------------- DATE11- ---------------------------------------- V QATE--- --- - -------------------------•-------------- REVIEWED BY------------------------------ --- - 15-- --------------=------------------- --------------------------------------- BUILDING PERMIT ISSUED--------- - DATE 0l� ---------------------------------- - - Alterations and/or recommendations- ----- ----------- ---- -----•---------•-----_----•------ ----------------�-;;�- � tr 4 ,�-a?- ------ ry ¢ '.' --------------------- ----- ---------------- ----------------- --------------- ..,... ------ ---- 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 145446 ATW000 12-54