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`~ 4 / ` APPLICATION FOR SANITATION PERMIT Permit No. .;�i � (Complete in Duplicate) - !� y l 6 � ,! �� Date Issued l /� ll, J`� Application is hereby made the an Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance Ncq,:2 549. JOB ADDRESS AND CATION-------------------------------------____.? ____.-.__. ___'_._.._______ ------------------------------------------ ------------------------------------ Owner's ------------=---------------------------------------------------------------------=--------------- Phone------------------------------------ Address -/1� �_ -------- Contractor's Name--------- ---- -------- � Phone --------------- Installation will serve: Residence Q'--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _--L._- Number of bedrooms __.mac Number of baths __/___ Lot size __ _.--, X_.79. --------------------- Water Supply: Public system �"Commuriity system -Private ❑ Depth to Water Table ft. Character of soil to a depth h f 3 fee+: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®-`"Hardpan ❑ Previous Application Made, IYes ❑ No 0'_ New Construction: Yes ®--No ❑ FHA/VA: Yes R—No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available.wifhin 200 feet.) Septic Tank: Distance:#rom nearest well_12-t14 _-Distance from foundation_____If_______-Material----�-�_--_ ❑/, �_ � � ------- No. of com artments--- � ----._--- Liquid de th---- _------._Capacity----- ...... �Disposal Field: Distance from nearest well- from foundation- !��__ __.__Distance to nearest lot line.--------_----- [],-� Number of lines-_____--_--s_.------1 =r Length of each line----------M/_--__-___.Width of trench_____�_�_`�___---__---_-- - -------- - Type of filter material-A/-A':*'`__Depth of filter material___ ./_/--_-.-Total length_-____-_9_ff_-_/_____________"_!__-_- Seepage Pit; Distance;�fo nearest well___`'3� �___Distance from foyndation___-�.�........Distance to nearest lot line---k-______ \ ©� Number of pits___-_r-------------Lining material__ Size: Diameter__s-�_� {_______Depth-_ ~.._-____--.---__- Cesspool: Distance)from nearest well-----------------Distance from foundation--------------------Lining material________----_______.__.______________ ❑ Size: Dia6fer----------------- ------ ------Depth----------------- -- -----F--Liquid Capacity------------------------- -gals. 1� Privy: Distance from nearest well----------------_------------------_--------------Distance from nearest building______________-______-_______..___._____- ❑ Distanceft nearest lot line---------------------- ------------------------------------------- ---------------------------------------------------------------------------- tl �� f Remodeling and/or repairing (describe)--------------------- �� '�'� 'Its it ,---='-�'`------- ------------------------------------------- - •-------------------=---------------------------- ------•--------------------------------- --------------•----------------------------------------------------- I� ----------------------------------------------------------------------- ------------------------ ----------------------------------------- - -------------------------------------•- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County + ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I -- -1- ------------------------- owner-and or Contractor " i--- -- (Signed)------ --- / ---------------------- (Plot plan, showing size lot, location of system in.relation to wells, buildings; etc., can be placed on reverse side). f' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B -- --- -- DATE ; ----•------ --------------------------------------- REVIEWEDBY----------------------�1 - ------------------------------------------------------------------------- DATE---3�------------------ BUILDING PERMIT ISSUED-1M_._____________________--_--- ---------------------- DATE---__--V- __-- --------------------------------------------- ------------=---------------------------- Alterations.and/or recommendations----------------------------- ------------------------------------------------------------------••------------------------- --- -•----------------•------------------------------"---------.1-------- - ' a - - ------•-- e, FINAL INSPECTION BY:----&_ae2._k--- ---- ------ 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 , Revisea 1-57 F-P.CO. �; IM