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r APPLICATION FOR SANITATION PERMIT Permit Nos, /__Al__d/� 22 (Complete in Duplicate) // 6%.S' Date Issued fflo.__:_______0 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 O ,T 10 , � - . - - " - -- ---------- ---'--'-'- -----------------------------------------•-=•�... - -------------------------------------------•--•------------------------------------------------------------- -y--- ---••••-- Owner's Name--- - ------------- �f - -------- Address f - -- --- --- ---------------•- Contractor's Name---- ------------------------ ----------------------------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence Apartment House E] Commercial Commercial ❑ Trailpr Court ❑ Motel ❑ Other ❑ Number of living units: ___-�__ Number of bedrooms3--_ Number baths P _ Lot size _. _ _ _ _-X,_Z,0_47_1_______________ Water Supply: Public system [:1Community system ❑ Private epth to Water Table ---_ ft. E] ❑ Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam Clay Loam Clay ❑ Adobe El Hardpan ❑ /(Previous Application Made: Yes ❑ No C-R New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool°`permitted if pub'c sewer is available within 200 feet) Septic rnk: Distance from nearest well __-______ ist om f and ion_ _( __.Matei '"" " `� -••3- No. of compartments__________________�_____,Sizesa?_�___X±f_e�t_ Liquid c�eptlt_.___'_ \_______Capacity___�_�V_ Dispos Field: Distance from nearest w � !``- istance from foundat'on_/P,,s stance to nearest lot linle1___- _ Number of lines------------ _ Length of each line__/ Width of trench_-_________ _ '� Type of filter maters _ _ __ --0epth of filter material......../ ___Total length_______________ �W, __.'Seepage Pit: Distance to nearest well__ __ --____________Distance from foundation___________________.Distance to nearest to ___-____-_ ❑ Number of pits----------_---------Lining material-----------------------Size: Diameter-----------------------Depth---------------.__- ,}.____-...: Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining tel -9- ❑ Size: Diameter------------------------•-------------Depth---------------------------------------------- - Liquid Capacity-. - s. Privy: Distance from nearest we1T-------------------------------------------�IIisfande --- 0 - Distance to nearest lot line---------------------------------------------------- Remodeling'and/or repairing (describe):......................................................................................................................................................... ---------------•-•---•-------------------------------------------•---•-----•------•----------------------------------------------------------------------------------•----------------------•-------------------------------- ---------------•---------------------------------------------------------------------------------------------------------------------------------•---------•------•-------•-----------------•------------------•--•------ 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:....... - -•- - - ----------------------------------------------------------- .....(T'itle)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY ---------------------------------- --------------------------------------------- DATE•%�'--------------------------------------------------- REVIEWEDBY--------------- ---- -- ---------------------------------------------. DATE... ............................................... BUILDINGPERMIT ISSUED.............----------------------------------------------------------------------------------------- DATE---------3r.......................................------- Alterationsand/or recommendations:............................................................................................................................................................... .......................................---------------------------------------------•--------------------------------------------------------•--•- •-••--•----•------•----••--•-----•--•--••-_..•------_....-•--•-•---- -----------•••--•••---------••----•-•-•-----------•----------•-•----------------------•-••----•------------•-•••-•••-••---------•-•-•--•••-------•-----•••••---•--------••••--•-•--•--•-•••••••-••-•--•--•-•----•----•------ ---------------------------------------------------------------------------------------------------------------------------------------------------•••-•,-------------------------------------------------------------------- -----------------------••----------------------------------------------------•---------------- ..............................................................------------------------ ._..•---•--•----•----••-•--•-----••- - .� FINAL INSPECTION BY:..."--=---"'---------- ---------------•------------------------ Date------- ----•----------- ---------_/---;-----------------------•-�- SAN JOAQUIN LOCAL HEALTH DISTRICT j 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 Revised W-2100