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APPLICATION FOR SANITATION PERMIT Permit No. .�2-_3 .-z- (Complete in Duplicate) /Z / . . _ Date issued ----_-- --v/ 4 — ~ 4ih�, plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. application is made in compliance with County Ordinance No. 549. JOB-'ADDRESS AND LOCATION-------- / •-.� - Owner's Name----------- _g__/.-...------ "� f�zl� � �?/�U��`��- ------------------- ------------- Phone--------------------- Address------------/_ 1 -------- 1 G f Q J • / -------------------------------------------------------------------....... Contractor's Name �[1111�C L-- ------------------ ------------------------------------------• ------------••-•------------------ Phone.-------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f-.____ Number of bedrooms , '5'- Number of baths /___ .Lot size ------ � - --- ---- -----------•------- Water Supply: 'Public:system M_ Community system E] Private E] Depth to,Water Table;_C-j4�ft. 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 Z No ❑ TYPE,OF INSTALLATION AND SPECIFICATIONS: p public Sewer is available within 200 feet.) Septic Tank: taDistancesfrroml nearest well: ~_._Distance from foundation: ..__ Material----<�� . ® No. of compartments.-__._. Size 1, 14 7 � _.Liquid depth -----�` --------Capacity----� -------- Disposal Field: Distance from nearest well-_-,_,7�.V._----Distance from foundation____,v�Z___9�....Distance to nearest lot line_-.,¢2-.<)-/-- Number of lines---------_ $U sz°- r -----. i Length of each line - y Width of trench ----7- ----- Type of filter material-/'- --5�i_Depth of filter material____.._:1_9- ,-Total length__ _________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation----------------.-_.Distance to nearest lot line----------------- F1 . Number of pits----------------------Lining material---------------- -----Size: Diameter-------- ------Depth--------------------------------. Cesspool: Distance from nearest well-----------------Distance from foundation---------- --------Lining material------------------------------------ El _._-___.:-__ _---__.____.______-.❑ Size: Diameter----------------- --------------------Depth---------------------------------- --------------.._Liquid Capacity--------•- ------ ---------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot fine_________ ________________ - a Remodeling and/or repairing (describe)------------------- ---------------------------------------------•--------•------------------------------------------------- ` M ----y: -----------------------------•--------------.---------pp---------------------•--q----------••-•----------- --------•---:-----------------------------------------------------------------�. I here6 certif that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances,&Sfafws, and rules and re ulations of the San Joa uin Local Health District. (Signed(= -- -- . •- - � ________________________ .-.-..-._-(Owner and/or Contractor) .- - -- - --------- - - - - ----(Title)--- By=-- . .. -- - - - ��- - -- - - -- - -- - - - -- � - ----- ---------------------- (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 APPLICATION ACCEPTED BY - -------------------------------------------- DATE-------------- REVIEWED REVIEWED BY - - -------------- --------._ DATE-----------�------------------•------------------------- BUILDING PERMIT ISSUED________________ ____ DATE.__.-._ �- ----------------------------- -----------------------------------....-------- ------------ Alterations and/or recommendations:. ---------------------------------- -----•-----=-------------------------------------- -------------------------------------------------------------------•---------- •-----------------------••-------------------•--.... ----------------------------------- --------------•-------------------------------•------------------------ --------------------------------------------- FINAL INSPECTION BY:_.---- " f..................... Date------ /?_ - - � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore,Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California s ES-9 145446 q-fWppD � l