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ek APPLICATION FOR SANITATION PERMIT Permit No. :5�... '?_ ._ r (Complete in Duplicate) f. , Date Issued ---------------------- Applica-�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 o. 5 ;q: 4. JOB ADDRESS AND LOCATION_.------ -� 1--`�-- E `�4 t � u ------------------------------- Owner's Name-----------------------------R--------H-Wal-n7. _ndel------------------------------------------------------------------------------ Phone-- ----------- Address---------------- --------------------------•--------------------------------------------------------------------------••--------- Contractor's Name------------------------------------------:�, e ° Phone :. Installation will serve: Residence Z Apartment House [ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:._-_.__,_,Number of bedrooms .2___ Number of baths -------- Lot size -------62_______---------_3�0-------------------- Water Supply: Public system W1 Community system ❑' Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay loam❑ Clay ❑ Aclobe,0 Hardpan ❑ Previous Application Mader Yes ❑ NoX New.Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �1 p No. of com artments_.____-_ a ` foundation------/!-------..Material---------------v oee ------------ Se Septic Tank: � Distance from nearest wel�=--_-f DZeanc��m��3_ - Liquid depth____._-_�.L"---------Capacity-_1_0 Disposal Field: Distance from nearest well....P-------- Distance from foundation_____ .......Distance to nearest lot line____ -----_____ ❑ Number of lines----------------I_._ Length of each line_______________�Q_______-Width of trench------------ k-)l-�'__________.._ Type of fitter material-------f I�_._Y __Depth of filter material______te_--------Total length_______________� ------------------- Seepage Pit: 'Distance to nearest wel!----- from foundation__..-_ld........Distance to nearest lot line____..5 ❑ Number of pits----j--------------Lining material---'_ P �---Size: Diameter---Y___ - ---------Depth--------Z_.*y_____________-- 1 Cesspool: Distance from nearest well________________Distance/from foundation--------- ------___Lining material__..____________-- ❑ Size: Diameter--------------------------------------Depth---------------------s;----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building____.________-__----_-_______________.___. ❑ Distance to nearest lot line------------------------------------------------•-- - Remodeling and/or repairing (describe):--------- ------------------------------------------------------ -•--------- �--•--`--•-- ----------------------------------------------------- -----------------------------------------•.---.---------------------------------------------.--.-----------------------------------------------------------------------------------------------------------------•----------- ------------------------------ --- --- --. -- -------- -- ---------------- •------•----------•----------------•--------••-----------------------_ •-------•----•---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance wK San Joaquin County ordinances, S ate laws, and rules a d regulations of the San Joaquin Local Health District. r (Signed)- r `- ----------------------------------------------------------------------------(Owner and/or Contractor) % By: =-------------------------------------- --- :--------------------------(Title)-------------------------------------------- ------------------- (Plot ------------------------(Title)----------------------------------- -------- ------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ---------- _. ------------------- DATE---------_--- _ REVIEWED BY_, ----- - ---- - �-"-- BUILDING PERMIT ISSUED------------------------------------------- ------------------------------------------------------ DATE--------- ---•- Alterations and/or recommendations:-------------------------------- -------------------------------.---------------------------------------------------------•-------- - F _____________________________________•__________________-_____-__________-______..___________________._.._.___________________________________________._______-__..._._.-_._..._______________-______________________-____..__ Y t FINAL INSPECTION -BY:-------------- ----- Date.- --- -------- r _ 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 Revixnrl W-7100