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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 3/ 1111 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the workh re'sn de cr'sbed. This application is made in compliance with County Ordinance No. 549. �p%fjpUs�+ Oil .S'otlf/f s�� of�e'�Nsh JOB ADDRESS D LOCATION - ----_-- �..... tJ fs-------- � ..-------. 2�1 _ Ql �pt� l-------- Owner's Name- -e.h-e-'�{ ►; --- �---c -e-1 f-------------------- Phone �i� � -- -- - Address_??_ -----------------------+ a _ew---•----X-Dd -:----- ------------w -- Contractor's Name_. / � o � _e _ �PJyu;<% Phone 2 � will serve: Residence Apartment House Commercial Trailer Court Motel Other Installation IIs ❑ p ❑ ❑ ❑ ❑ ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size -----------------------------------------------------__._-- f Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. v i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Distance from nearesr well__==----------'Distance from foundation_'-_.-.-: _ Material_________________________________________________ , No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity-••-------------------- Disposal Field: Distance from nearest weft-----------------Distance from foundation--------------------Distance to nearest lot line-----------.----- ❑ Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------- Type of filter material------------------------Depth of filter material-----------------------Total length---------------------------------------Ir ---- Seep it: Dis#ante to nearest well_ ___-__-Distance om o ndation-__,h______Itifto nearest 4ot lme__f_-1__Number of pits.-i/_______________Lining material _ _--_ _ -.-Size: Diameter__ °_Depth__ Cesspool: Distance from nearest well____.__________-Distance from foundation--------------------Lining material-------------------------------------- F1 __.__._._____-.___-____-_____-__ _ Size: Diameter---------- -------------------------- ---Depth--------------------------=-------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-____-___.___-____________-__,_._._---... ❑ Distance to nearest lot line-- ---------:-------------------------------------------------------------------------------------------- ------- - - Remodeli and/or repairinij crib ------------------------------------------------------------------------------------------------------------------------ - •----- -- ----- -- ----- --- - -- ; • u------------------------------•------•-----------•------------------•--------------- -----------•----------------------------------------- ---------------------------- ------ I hereby certify that I have prepared this application and +hat a work will be done in accordance with San Joaquin County ordinances, St laws, and rulgsAM d�reg�lar s of the San Joa i Local Health District. a Ly f1Y , Septic Tont¢ Service_____ ____ _________ (Owner and/or Contractor) (Signed)•---- �^ -- ---- ----- -- - -------------------------��V�•So:i=�'doratfo 1�f0 2-7Q46 F ` By=------------- Sfr-.cktass,-�lif:----------------------------- -- - - --- ------ --------- ------(Title)-- - ��f��----------------------------------- (Plot plan, showing size of to+,-location of system in relation to/' buildings, et ., can be placed on reverse-sigle)d-. t = OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------------------------------- ------------- DATE----- -------`------------- - REVIEWEDBY-_------------------------------- ---- --- -------------------------------------------------------------------------------- DATE------------ -----------•---------- -------------------- BUILDINGPERMIT ISSUED------------------ -----------------------------------------•--------------------------------------- DATE------------------ Alterations and/or ret-mmend ptiions---------=----------------------------------------- - - -- ---------------------- ---------------- --= .' ---------------� ,. � ` ' ;1 -----:�----- �- �-- ---------- ------- - f -- - --------------------------------------------------------------- -----------`-------------------- ------ ---- — - ---- -------------- ----�--- ��------ --- - -��- - -- - ----- ------------------------------- FINAL INSPECTION BY Date =---- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Sire** -� Stockton, California Lodi, California Manteca, California Tracy, California ES-9---2M , Revised 1.57 F-P.CO.