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/ APPLICATION FOR SANITATION PERMIT Per o. . '.. � I (Complete in Duplicate) 41-1 ( `'r 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. JOB ADDRESS AND LOCATION............-----3 f.a --- - •... --.—_141 _ Owner's Name................. ....... ---- .. -- ---••-. . •--•----••---•---•------------- -------------------------- ----------------• Phone-- `-3 . ' �s ea4 •--•-- ,------------------- ------ Address-----------------•---------------------f-�.----- .} Contractor's Name //` a- ./ -.-------------------------------------- -----. Phone---2�-----�------- - � -4 Installation will serve: Residence [r' X'partment House ❑ Commercial ❑ Trailer Court ❑ Motel f] Other_ ] Number of living units: .___ Number of bedrooms _.3_ NUrnber"'of"i�aff s` 'Lot size ..... ! _ ._ .....--------- Water Supply: Public system 9�--C-ommunity fystem [-] Private E] Depth to Water Table .-Y4. ft. Character of soil to a depth of 3 feet: Sand . Gravel E] Sandy Loam E] Clay Loam ❑ Clay❑ Adobe�ardpan ❑; Previous Application Made: Yes E] No [I� ew Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.}.- Septic 10: Distance from nearest well y---Distance from foundation..Ap_.........mat r I- C C--------64410---------_ No. of compartments----_-a--. ___- __-Liquid depth"' 1:7-:-_.--___-_ Capacity. 800 . .E Disposal eld: Distance from nearest well��-._Distance from foundation i Distance to nearest lot line................. 1301 Number of lines........./------ _- ___ -Length of each line........7xr.. _ .Width of trench-----�4�AO................... Type of filter materials oCA< Depth of filter material.. ; ------ Total length.......2S"__ Seepage Pit: Distance to nearest well_ ________________Distance from fo ndatioti AO_ bistance to nearest lot line Number of pits..... --- _.----Lining mate ria l.41-A .Size: Diameter----- ...........Depth-------------------................. Cesspool: Distance from nearest well...--------------Distance from foundation--------------------Lining material_______-----------------------....... ❑ Size: Diameter------ --------------------------Depth------------------------------------------- -------Liquid Capacity.............................gals Privy: Distance from nearest well-_____ ___________________ _____ __-___-.-----Distance from nearest building__'____ ____-______-------_._.___-__- 3 ❑ Distance to nearest lot line-------------------------------------------- ---------------------- --•--- --•-------------------•- Remodeling and/or repairing (describe) ---------------------------------------------------•--•--------------------•-------------- --------------••-----•----------------------------•----- ----------------------------------------------•----------------------------------------------------------------------...-----------------------------------------............................................................ -------------------------------------------------------------------------------------------------------------------------------------•----------------..........................-------•----------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in adcordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. - � ,,�t- t f 174 � . -� ... ___ -( ner and/or Contractor) (Signed)--------�-------------- ---•------•--------------•----- ----------------------- -....- --•--•- - ------------------------------------- By:----------------•----- .. +�.- - ...............................................(Title ----- --------- --- tam••--�-�� ---- ----------------- (Plot plan, showing size of lot, location of system in elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---- •---••....... z-••------•--------. DATE--••-•. ------ REVIEWED BY-------------------------------------- % ------ DATE..............}� � BUILDINGPERMIT ISSUED-------------------� ------------............--------------•------------------•----•-------------_. DATE----=----------•---- Alterations and/or recommendations-------------- ->.,_. •------• . --------••--•--•----------••---•----_._ ....._.......-------•-----•-•-•-•---•-•--•-•-•---•------•--••------. ------------------•------•--------------------------------------•--....•..------............-----------------------------•--------•---•-----------------•-•-------•---------••-------••-•----------------•-•--------. 0 -----------------------------------------------------•------------ --•------------------------------------------------------------------------•--------------------•----------------------- ................. -------•------------- ----------------------------•-------- -•-----------------------------------•----•-----••...--•---------•-------••------•----•-•-•-••-••-••-----••---•------...•-----•--••--•----••--------•-....__. -----------------------------------------------------------------•--•--------------------------------------..------------------------------- ------.----------------•-•-----•-------------------•--------------------------- FINAL INSPECTION BY:.-_° ..`..---.''. --- ''' --` `--"'--- ------------- Date...._ _ _:__. ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North Stockton, California Lodi, California Manteca, California Tracy, Californ ES-9-2M Revised W-2100