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APPLICATION FOR SANITATION PERMIT Permit No. 9_______ (Complete in Duplicated Date_Issued ___-/!1 3_ __ 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 Or& ante No. 549. ` JOBADDRESS LOCATION-- -Z. r ...... --- -------------------------------------------------------------------------'--------------------------------------- Owner's Name---- r ---:-------- - - .. ---- --= Phone _ -- -- -------- - -- Address----------------1:�--- -- --------------------- -• --------------=----------------------•------•----------------•-----------------•----•-----------------•----------------------------------------- -- -----------------------•---------- -' Con+rector's .Name--- --------------------------- ---__ � � i ---------- Phone._.. Installation will serve:plResidence Apartment House ❑II Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1 umber of bedrooms __p____. Number of baths -------- Lot size _ _4/___f__.x- �� Y r. Wates Supply: Public s�stem��. Community system ❑ Private ❑ Depth to Water Table ._:_____ ft. �s 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 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.: i; a (No septic tank or cesspool permitted if public sewer is available within 200 Septic Tank:. Distance from nearest well____________ ____Distance from foundation---------------__-__.Material-------------------------------------- .________- ❑ No. of compartments :------------Y------Size--------------------------------- Liquid depth------------L- --------_Capacity----------- ------ Disposal Field: Distance from nearest well_________________Distance from foundation_____----------I....-D-i'stance to nearest lot line------:_______--- ❑ Number of line-----±--------------------- -----Length of each line-------------------------------Width-of french------------••--------------------- 3 1 Depth of filter material--------------__ _____Total length______-___--_______--____________________ eepage Pit: Dista pe toen a st,well______.__-'-_'"___--Distance from foundation__:-___'�_'-'Distance to nearest lot line_________________ '- ❑ Number of pits------ -Lining material-----------------------Size: Diameter-----------------------Depth-------------------_------------- M, cesspool: Distance from nearest,well___._______.____Distance from foundation__ Lining material______________________________________ N ❑ Size: Diameter_--- = ------a------;-------`Depth -- -�_,__Liquid Capacity------- --------------------gals. � Privy. Distance from nearest-well � '--___ _ ____ Distance from nearest building._ -_�'M-E%Y✓ _._. ' . _ - -_ •'Distance to nearest#lot line -- --- -----------------------•-}'---------------------------- ----�--- �-....-------------------- Remodeling and/or repairing (describe):-------------- `... .....--------j- I-- "----------------; E........._.. ._. _ ,---------------- .------ ----------•------, T = `' - -- ", ........... ------------------------- ---------------------- �J - - -� � � C+'� f ---- ------------------------------------ ---:----------------------------------------------------------------------------------------------------------------------------------------•---------=-------------------------------- I hereby certify that-1 have prepared this application and that the work wilFbe done in accordance with San Joaquin County ordinances, .State laws'and rules and regulations of the San Joaquin Local Health District. f .. {Signed) r .f i I ------------ -5------- -- -------- ------------------------ (Owner and/or Contractor) - By:_A .c ". ---------------- ------------------------- ----- - ---------------_-(Title)--------------------_t----------------------------=---------- (Plot plan, showing size of lot, location of system in rela ion to-wells, buildings, etc., can be placed on reverse side]. - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------ -----_ DATE.:.,---------- ---------------•----------------------- REVIEWEDBY �`---------------------------------------------- DATE----- --------- ------------------------------------ BUILDING PERMIT ISSUED------------- --- - ---------------- DATE-------- �_ f -------------------------------- .Alterations and/or recommenda+ions-------------------------------------------------------------=----------------------=-----------•-----=----------=------•---•------------- ------------- .-•--------------------------------------------•---------------•--------------------------------•----------•--._.....- -------------1------------------ ........................................ I # t -----•-------------------------------- ------•--- - ----•--------------------- ------------------ ------------ --------------'--------------------- - ------- ----------- -------------------------------- --------- t• f r - r Y ................. -- -4 /_-S �- .2'.�j. FINAL INSPECTION"BY.:- ------ Date 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 t ES---9-2M ; . Revised W-2100 i—