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1' ! ! APPLICATION FOR SANITATION PERMIT Permit No. .... ............... Duplicate)(Complete in Du c P ) Date Issued 2-1 Applica=ion is hereby made! ade o the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in •ompliance with County Ordinance No. 549. �_ oh---�@S� $/ec-`e_ Z0----------- I---4�ref'-CK9Ch r � JOB ADDRESS AND LOLC�ATION...----------_ - h r ' Owner's Name----�-L_a_ 11-I1'---- _ Ud_ N._ f-�'----------------- Phone___-� -�- --------- -------------------------------------------------------------- - Address_..._3-1�-----`�5- hd.�� ' F v-o� ----------•--------------------------------------------------------------------------------------------------------------------------------- Contractor's Name------ I--------- -------- -- ----------------------------------------------------------- Phone--- -�f-' _ Z' ------ Installation will serve: Resilpence Z Apartment House ❑ Commercial E] Trailer Court C1 Motel [:] Other [:1Number of living unit : J --.- Number of bedrooms _ Number of baths .-.1___. Lot size _____-- _ -9________________ ______ Water Supply: Public sysfi�m ❑ Community system ❑ PrivateK Depth to Water -Fable ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)K Hardpan ❑ Previous Application Madel!Yes ❑ No t4 New Construction: Yes 0 No ❑ TYPE OF INSTALLATION 1AND SPECIFICATIONS: (No septic tank or c Nsspool permitted if public slewer is available within 200 feet.) " Septic Tank: Distance p from nearest well________.___Distance from foun ation___________________Material_____ No. of qt J- /��)C --L', p Capacity ompartments ------------- Size----- quid de th - Ca aut D:sposal Field: Distancl from nearest well_-. _-._Distance from foundation__�_ ..- ---.-.Distance to nearest lot line________. Numb4of lines------3--------------------------Length of each line-------�Q-_y.;--------Width of trench----- _____.-_____-_----- S Type o- filter material_, _r-___�.-___Depth of filter material----�__?____________Total length_________/__PC____________________ %jj ` Seepage Pit: Distance to nearest well---------------------- from foundation----------------=..Distance to nearest lot line_--_____________ W n Numbe��of pits-------------=--------Lining material---------------------- Size: Diameter-----------------------Dept'h--------------------------------- Cesspool: Distanule from nearest well•_________________Distance from foundation----__-____________.Lining material-_.____________----_______________. ❑ Size: Diameter---------- ----------------- ---------Depth--------------------- -------- --------------------Liquid Capacity----------------------------gals. .0000, Priv Distance from nearest well________________________---_ ____.-Distance from nearest building Privy: ---------- g--------------------------------------- El --------- ------------------- - -----❑ Distance to nearest lot lire----------------------------------- ---- Remodelingand/or repairing (describe):-------------------------------------------------....------------------------•--------------------------------------------------------------------------- !IMI --------------------------------------------------------------------------------------------------------------------- ----•- ---------------------------- �-------Ili----------� -------------------------- --------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- �ill ---.-------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ---------------------- I hereby certify that llhave prepared this application and that the work will be done in accordance with San Joaquin County ordinances. St to laws, and rules and regulations of the San Joaquin Local Health District. --.__-__-------------------------------------------- _-__Owner and/or Contractor I- ( / ) (Signed)-- -. BY=---------------------------IIII .......-----------------------------------------------------------------------------------------(Title)---------------------------------------------- --"--------------- (Plot plan, showing size of dp t, location of system in relation to wells, buildings, etc., can be placed on reverse side). �lU FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- --- ------------------- -- - ----- -------k--- --- ----------------- DATE --:------------------ REVIEWEDBY------------------ -------------- ---------------------- - -------------- -------------------- ------------------------- DATE--------- ------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- al, Alterations and/or recommendations:----------------- -------------------------------------------------------------------------------------------------------------------------------- ._.-------- ---------------------------•-......-- -- ----------•---------- -------- ---------------------------- ---------------------------------------------------------------------------------------------------------•--•----------- ---------------------------it ------------------------------------------------ ------------------------ --------------------------------------------------- --------------------------------------- al ------------------------------------------------------------------------------------------- FINAL INSPECTION B) -------- - A��--------- Date-------- / ------ --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American 5+refit 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California ES-9-2M Revised W--2100