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-k APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued + sh A Joaquin Local Health District for a permit to construct and install the work herein described. Ap Thisplicaton is hereby made to the San application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION....��--- ��......... -------------------- ------------------------------ --------------------------- I ---------- f Owner's Name---------C:r-_ ?--------- &: '_ ------ ----------------------------- - ------------ ------- Phone r ,�` l _ ... s E• `__'- ------•------------------------------------------------------------------------------- Address-................ ..... Contractor's Name-----.. " - f4lvr,'{ �- --------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ --�-�--1-�_&----------------------- - Number of living units: .___ Number of bedrooms � /__ Number of baths ._.___._ Lot size .__.____ 11 Water Supply: 'Public'system �- Community system E] Private E]- Depth to Water Table 'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: Yes ❑ No 2�r New Construction: Yes ❑ No �� TYPE OF INSTALLATION AND SPECIFICATIONS: .;" (No septic tank or cesspool permitted if public sewer is available.within 204 feet.) f . . Septic Tank: Distance from nearest well_ '+ '"`Distance/' v� from.tom foundation�__._ -._.__.__.Mateaf___ __________________._:___�__ _______ _x _ C- - -Li uid de th.--- _:M Capacity No. of compartments --- -----Size --- - q P. ,, ... s r ._.Distance to nearesiot line_________________ f Dispo Field: Distance from nearest well..�1T '''Distance from founds I�,'-r- Width of trench._____ _F1�_______________________ L Number of lines------f-_____.- ec_Length of each line__ ___ ______ __ ______ �. �, �-- " _Total length-----�'�--------- Type of filter material_f�__ Depth of filter material___�a ___-r-.-_ •� f 40 Seepage Pit: Distance to nearest well_----h s,('Distance from foundation_,/i�_}___Z_.Disttan e to nearest lot line-—----______- a- [ Number of pits....______________Lining material_��_4-� ! Size: Diameter-_,,-7-....--------Depth--------- ____________-. F ? Cesspool: Distance from nearest well-----------------pistance from foundation ------ _Lining material----___________________ _ i Size: Diameter-----------------------------------.Depth_.---------------------•-- = .Liquid Capacity -----gals. ❑ _.._Distance ;from nearest buildinr, Privy: Distance from nearest well ------ -------------------- --- ---- � g----------"-- -------------------------" ! ❑ Distance to nearest lot line------ - ---------------------------------------------------------------------------------- -------------------------- ---•----------- �6 ` ------------------------------------------------- Re modeling and/or repairing (describe):--- ---"f�`17IT. , �""' 1.----- �`�'��- ------------------------------------- -------------------------------------------- f r ' ----------------------- -----------------------------------_--------------------------------------------------_----------------------------------------------------------------------------------------------------------_____________ F 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 L"ocal Health District. (Signed)---------------- 1JO rhe- ', - <.*c 3� ` r Contractor) g {ice/ 'l `° -- --------------------- (Title) •• .-� Y:_----------:----- f/"-�- (Plot plan, showing size - �, location of system in relation to wells, buildings, etc., can be placed on reverse s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- .x ---------------------- ------- DATE-------' ------- ----- --------------------------- - ------- -- REVIEWEDBY---------------------------------------------".-_------ --------------- -----------------.------------ DATE -----------------------•------------ DATE------------- -----------__�?PERMIT ISSUED-------------------------------- -------- ------- ------------------------------------ �------------------------------- -------- ----- ---- ---------------- Alterations and/or recommendations________________________ -- ------------------------------------------ - ----------------------- ---- x^ " - ----- - - ------------------•-------------•------ ------- ------- ------...... ------ - -- a ------- -----•---•----}--------------------------------------------------=----------------------------------------------- ----------------- FINALINSPECTION BY:-,-.---- --------------- Date.....J-_------- --------- -- -------------------------------------- - n y SAN-JOAQUIN LOCAL HEALTH DISTRICT f 32 Sycamore yStreet it �" 814 North "C" Street 130 5oath American Street 300 West Oak Street Y , Stockton, California Lodi, California Manteca, California Tracy, California E 5--9 145446 nrwoao