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S APPLICATION FOR SANITATION PERMIT Permit No. A ____ (Complete in Duplicate) Date Issued __.___l y/&v Application 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, JOB ADDRESS AWD LOCATION-- � �'� A /cif - -6-`) —-------------� 7o Owner's Name----------- �- --•-------� �-c_a- `' r— - - --------------------------------------- Phone-------- --------------------------- Address__...-------- � - -------------------•-------------------------------------------------- Contractor's ----------•-•----------••-------------------•---- Contractor s Name_____.__... ---"�--•�----•--- ---��'t_�f� �.� 4-------—---------------------- Phone--�-�D_��}��--� Installation will serve: Residence�Apartment House E] Commercial E] Trailer Court E] Motel ❑ Other ❑ Number of living units: __ _- Number of bedrooms _,2--Number of bathsLot size r +� -------------------- (_�3 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _ eft. k Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam E] Clay Loam E] Clay F] Adobe `` Hardpan ❑ U Previous Application Made: Yes ❑ No New Construction: Yes El J PHANA: Yes ❑ No;? TYPE OF INSTALLATION AND SPECIFI ATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) ptic T �� Distance from nearest well_________________Distance from foundation_________-___----,Material ________________.__-_______. 4- No. of compartments--------------------- Size---------------•----------------Liquid depth--------------------------Capacity----------------------- , Disposal I! Distance from nearest well__ istance from foundation__/t9--------Distance to nearest lot line___'Q------- e _—-- �o 11 . Number of lines-------/-------------_------------Length of each line___--- - __f Width of trench__"_ [ p f 2 ------------------ Type of filter material-_ 4+_ •� -__--_De th of filter material____._______.___.__"Total length___-__-��____-------------------- ' h l Seeea Pit: Distance to neareste!I-____f1�2 ,� ___Distance fr y foundation___ �________-Distan•serto nearest lot line___ ___ Number of pits______ .______Lining materral_____�-___._<��Size: Diameter---- Deptn_._c�-�- ------------------ i CeXsool: Distance from nearest welL________________Distance from foundation--------------------Lining material_____--..____.___________-- ------- ❑ Size: Diameter-------------------- ----------------"Depth-----------------------------------------------------Li uid Ca acit - q p Y- --------- --------------gals. � r , Privy: Distance from nearest well_________._____- _______ --_-_Distance from nearest building Distance to nearest lot line----------------------------------------------------------------------------------- -- - - ----------------------------------------------------- Remodeling and/or repairing (describe):___, --------z2 _--_---_ j [ ----------------- y ---------------------------- ----------- y - ---------------------------- ------ ------ ------ ---- ------ ----- - - --- - - -- ----------- ------ ----- ------ - --- ------ -- - - -- - I hereby certify tha I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State e.__ d rules and regulations of the San Joaquin Local Health District. (Signed)------------------ 5 -zc t --t-- '- �.��r"'—'�� - - -- --- �-may '________ Owner and/or Contractor) By -� � -- --- -------- ------Title------ --- �r-- � (Plot plan, showing size of lot, location of system in relation to wets,)buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY________ _________ ____________ ___ _ _ - --------- --- - - --------------- ----------------- RATE------- -- ---- --. ------ REVIEWED BY ------------------------ ------------------------------------------- DATE------- f 5 BUILDINGPERMIT ISSUED------------------ ------ - ------- - ----------------------------------------------------------- DATE------ Alterafions and/or recommendations:- ------------------------------------- ---------------------------------------------------------------------------------------- -------------•--- ---------------- ---- ---------- ��. u -- - � u-�r ----- ----------�-- ------------------------------ ---------------------------------------•-------------------------------------------------- ---- f i FINAL INSPECTION BY:. --------------- ------- ---- Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT _ 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Straet Stockton, California Lodi, California Manteca, California Tracy, California ES-9---2M , Revisea 1.57 F.P.CO. t