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A., APPLICATION FOR SANITATION PERMIT Permit No. _., ....... (Complete in Duplicate) lica ion � Date Issued ....9.,��,ls__�_ A pp +' is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 0his application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-----I-g-1 bn '_ ---------------------------- Owner's Name • ►y, /t,�.+�---••------------------------ ------- -------------------- - Phone-- 11 -7 7Y . . Address -------------------------------------------------------------------------•---------•_.._..-------------................................................................. Contractor's Name , '`----------------------------------------_- ------------ Phone./�!'.._;. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Q' Number of living units: ---I--- Number of bedrooms :' '. Number of baths __1____ Lot size Q� . -__________________________ Water Supply: Public system Community system ,[-] Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel;❑ Sandy Loam ❑ Clay Loam El Clay F] Adobe(Hardpan E] Application Made: Yes F] No New Construction: Yes []'—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------------------Distance from foundation....................Material. No. of compartments---- ------------ ----Size--------------------------------Liquid depth--------------------------Capacity Disposal Field: Distance from nearest well ________________Distance from foundation---------. ---=_._.Distance to nearest lot line................. CNumber of lines______ _______ __---------------Length of each line----------.-------------------Width of trench---------------------- Type _____-_________.Type of filter material-_-.__...._-__--_-_---Depth of filter material-----------------------Total length___________________________________________ Seepage Pit: Distance to nearest well. -------Di' oni nd _ ation_ _. Distance to nearest lot line__ __ \ Number of pits__.-_ I--------------Lining material.... .... ..... ..Size: Dia __'} - ---------Depth' - - -------•--------••- Cesspool: Distance fiom nearest well_____________ ___Distance oundation._._=.__.-.-__.__ Lining material................................... __ \' ❑ Size: Diameter----- - ---- ---- -- -Depth----------------- -- ----- --- Q, Liquid Capacity gals. Orivy: Distance from nearest well_--------------. --------------------------------Distance from nearest building___.._ -_._._..........._,..___._.............. . ❑ Distance to nearest lot line---- - YYY Remodeling and or repairing (describe):---C - U (°� -- --- ------ -- ----------- ------ V ---------•-----•-•----------•---------------------•----------------------------•---- -• -------------------•------------------------------••--•-•------------__-----_,_-_--__ -----•-- -----------•--------•----- ---------------------•-•- ------------------------•-••-----•--•----•---------•-••---•----••---•-----•••-•--•----•---------•-•-•--•--• ---••-- -----• --- ---� . 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. (Signed .. ......... _. (Owner and/or Contractor) By:.................. -•- - ---w`�' ,v``------------•- --------------------------------------------------•(Title) (Plot plan, showing size of I location of system in relation to wells, buildings, etc., can be placed on reverse si e). 2 P. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ----- - - ---- DATE �� DATE �� REVIEWED BY--------------------------------------------- ----------- ------------- --------- --------------------------------- ------- BUILDING PERMIT ISSUED........................---•-- --------- ------------ , Alterations and/or recommendations:- -------- --- ---- e�= 1 4`�l�x-'�"� •-----j -..r ---..s#-_44_.... -------'�GCrCI Q_e ... � '��'* r'-�*' cg'sT /, cSG?sIAG �rCJ........!!vt....................... j ---•------------ -•--------------• '° d- �� r----- s --- - - ---- ----------- --- - -- -----•----•-- ----- - -- --- --•------------------•-------------------------•------------------------------------- •--•---•-------- -- / FINAL INSPECTION BY:.. --------------------------- Date........ "�.�,1------ 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 145446 ATWODD