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Permit No7 P . .- .. . 7 ... APPLICATION FOR SANITATION PERMIT - (Complete in Duplicate) 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 No. 549. �j ; � ----- ---------------------- --- ------S- O es�: - QL_�------------------------------- JOB ADDRESS A LOCATION• - .: l- ¢ ....__- Phone�-1�--Owner's ----------- - L - •--- - - ..... --- ---- � --Address--- ----- Phone----------------------------------- Contractor's ----------------------------------Contractor s Name_______ ______ ✓ ----------------------- Installation will serve: Residence La Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot ❑ Other ❑ P Number of living units: ___j__ Number of bedrooms _____ Number of baths __-1-_._ Lot size ----- rr-!-U-(�--------------•------- Water Supply:I Public system 0--Communify system E] Private [-] Depth to Water Table -------- ft. Character of,sc.�Vto'-a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe c❑--I-lardpan ❑ Previous Application Made: Yes ❑ No �New Construction: Yes ❑ No a— TYPE OF INSTALLATION AND SPECIFICATIONS:_ - p� (No septic tank or cesspool permitted if public sewer is available within 260 feet.) V Septic Tank: � Distance from nearest well__;________...__Distance from foundation___________________Materia______.______-__:_ Size--- ----------------Liquid depth-------------------------.Capacity----------------------- ❑ �I,f f0/No. of compartments--------------------- / Disposal Field: Distance from nearest welL�a!�A_Distance from-foundation_-_______-_____Distance to nearest lot lineIr � .r- ---------Length of each line------- :-Q --=---SWidth of trench.----_ :5�------------------ YP r g �- --------- Type --••---- Number of lines---- ------------ ='-- T e of filter matenalf_-:- . 1 �0- --,Total length______ •----•------------•- /- -Qe fh of filter material___--/'_�.� � � � � s Seepage Pit: Distance to nearest we1C_/ � ---Distance f m foundation___y______-__.-_'-.Distenc�,to nearest lot .ine___�_____..___.. f g. ►_C_� Size: Diameter.- ` -=-------Depth------,: -'�'--------------- Number of pits_.-- Linin material._ # / f Cesspool: Distance from nearest wel -----------------Distance from foundation__-----_____ ______Lining.material____:._.__-_____:.,__._-_____.____. . Size: Diameter ----------------------------- Depth ---- ---=- =1 Liquid Capacity 3'-=- gals. ❑ Distance from-nearest building----------- -------------------------- I Privy: Distance from nearest well-------.-----------'--------- - ---- ------------- ----- -•--------- ❑ �Djstance to nearest � --- - �---- • --------- --F r st { R # � �V� lot li --- -- --- ----- i7 - l Remodeling and/or repairing (describe:____ - -. ---------------------------Z__�-____..-_._.- l ------------------------------- I _______________________ _..______�______________________________________________________________•-____._-_______-___--.________-___._.__-_-__________.-_________.-____-____-____--___--_______-__._________..__.___..__.__-___________._..__ 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 ws, and.rules and regulations of the San Joaquin Local Health District. (O er and/or Contractor) f - I- f -- ---------- ------------------------------------------- ------ (Signed)---:--- - ------- - ----------------------------- ------------- ------- - (r+le) ----------- (Plot plan, showing size of lot, location of s s+em in relation to wells, buildings, etc., can.be placed on reverse side).' FOR DEPARTMENT USE ONLY --------------------------------•--------------------- DATE---------/ --------------------------•-------------•---- APPLICATION ACCEPTED BY DATE-------------- ------------------- REVIEWED BY--- :-------------------------------------- ----- ------------------------------- BUILDING PERMIT ISSUED: ------------------- - - ------ ...... ----------------------------=--------------------- DATE------------ Alterations and/or recommendations________ __ ----------------------------------------------------- •..._.. _____ -- :_ ----------- -- ----------- ------------- a ------------------------------------------ - ------------ --------------------- - ------ Date- ----------- --------------------- FINAL INSPECTION BY---------------- -------. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North '•C'• Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. E5-9--2M 145446 ATwdO� 1x-54