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Permit N'o:'�_ _ �------�- Y APPLICATION FOR SANITATION PERMIT � 7 (Complete in Duplicate) I Y � � Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal the work her in descr'sb This application is made in complian -th County inance No. 549. LOCATION__ . .' x- = ------------- ---------�-- 2 JOB ADDRESS AND , ,�p / Owner's Name-----------•------------------ �� r1 Phone =• �.. Address-------------•-•--------------------'----------- -------------------------------------------------------- -------- ---------------------------------------•--------- --------- Phone..---- ------ Contractor's Name. ' E- Installation will serve: Resident g Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livin units: Number of bedrooms _—-Number of baths ---r. Lot size _ ___ ---- ------------- g —, _ LL _ Water Supply: Public system ❑ Community system ❑ Private;RLDepth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe KL Hardpan Previous Application Made: Y No-o New Construction: YesZ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: # k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest welled q.,-4_"fl A-le ---______ ize e from foundation/-_ _____________Materiae__ _-__ _ ______ ____._ _ __ __No. of compartments___________ __.__Size_ _ _._ __ ____ Liquid depth__. '7►_ -________Ca aci# __� p y _-_.Distance from foun ation____________________Distance to nearest lot line.------------- Disposal Field: Distance from nearest well------------- .._ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- 1 Type of filter material---------.----------------Depth of filter material---------------------Total length---------------.--------------_-----•�-- P 9 1 ao nearest well_/- _ -- Distance from undation_ __...____.Distance to nearest !qj lines-lo------- Seepage -____. See a e Pit: Dis�ance: �" of its____ Lining material ___. __ -Size: Di ameter____ 3-��-__.Depth__ _6_--._________________ p Number p' /----------- f Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material-__________.--._____________-_-_____- ❑ Size: Diameter--------------------------------------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. r Privy: Distance from nearest well--------------------------------------------------Distance from nearest building----------------------------------- ❑ Distance to nearest lot line------------- - ---------------------------------------------------------------- --------------- ------.--------------------- kA Remodeling and/or repairing (describe):_________ ---�/f�---f ----- - . ..... ..... . .. `-----_----------------- -- _ - ------ `� •------- --•-----------•--,------- ---------------------•--------------------•------------------•---------------------- - ! hereby certify that I have prep"~th' application and that the work all-be done in accordance with San Joaquin County n, ordinances, State la , a6d.rules and regulatio of +he San Jo quin Local lealth District. !V 1 (Signed) F � 2 �� - Contractor) 11 ` �J --------------------------------------------------(Title)- J -=S1-�`CL� -1------------ By: �" (Plot plan, sho size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- ----- ---• --------------- ----------------------- --------------------------------------- DATE--�--------------------------------------------------- NG PERMIT 155DED------- --- -- ---- REVIEWED ------ BUILDING --- , _ DATE, BY ------ DATE. --- :e----------------------------------- •_----- Altera+ions and/or recommendations----------- ------------------- ---------------------------------------------------------------•---•---------•----------._.-...---•------------ a ------------------------------•--------------------- ------------------•------------------------------------------ ------- ---------------------------------------------------------- n rn FINAL INSPECTION BY:-/0 -------- -------------- Date _ rJ d -------------------------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streo+ 30o West Oak Street 132 Sycamore Street 814 North "C" Sfree+ Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 8.51 Revised W-2100