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\pl—ke u APPLICATION FOR SANITATION PERMS , Permit No.Al (Complete in Duplicate) Date Issued ___��___ Application 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 AND LOCATION..._ ?' s `-------------------------------------------------------------------------- -- c �1 Owner's Name------- -------- ----------------------.Phone-----------------------'--------- -- - -'---- - ----- Address------------ -----��-12-----------/0-?_47_W_77------ - -------------- ------------------------------------ --- --- Co4or's Name---------------------- G' / i Installation will serve: Residence JZ Apartment House ❑ Commercial 0' Trailer Court ❑ ',M E]otel ❑ Other Number of living units: -------- Number of bedrooms ___2- Number of baths -4____ Lot size _______.-_____.__________________________________________ Water Supply: Public system,'® Community system ❑ Private ❑' Depth to Water Table ------I ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ clay Loam ❑ Clay ❑ Adobe j D Hardpan ❑ Previous Application Made: Yes ❑ NocJ New Construction: Yes No ❑i FHA/VA: Yes ❑ No� l , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within`200`feet.)—, aF { ! Septic Tank: Distance from nearest well-________________Distance from foundation•--------------------Material_______._____..______.________________--_--____. No. of compartments--------------------------Size------------------ -----•- -----Liclj GiT d de th------------------ Capacity Li Disposal Field: Distance from nearest well _______----------Distance from foundation------_____________.Distance to nearest lot line_________________ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------------------..-------- Type of filter material_________________________Depth of filter material-----------------------Total length__________________________________________ Seepage Pit: w Distance to nearest we 1__!!�_ '" '_ _Distance from foundation_____, Distance to nearest lot line__,.?__ X1 Number of pits-_"----- -------------Lining material-----_- -------Size: Diameter------3�_.__-------Depth--_------° 5--------------- Cesspool: Distance from nearest well-e4_:7Lto_-Distance from foundation__ _'*......Lining material-------------------------------------- El Size: _________._ -_________- Size: Diameter--------------------------------------Depth------------------------ ---- -----------------.---Liquid Capacitygals. ( Privy: Distance Srom nearest well----------------------------------._._ __.____.-_Distance from nearest building.________________________________________- f ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand repairing [describe�: --------------------------------------=-----=------------------------------------------------------------------------------------------ ------=----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------•-------------------------------------- 1 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. Si ned T` Owner and/or BY=--------------------------- ------------------(Title)--------------------------------------------- - (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----77r+__F--C�-7--------------------------------------------------------------------- DATE-------` 60---------------- - REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------•---- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------ - ---------------------------- 1. Alterations and/or recommendations____________________ ------------------------------------------------------------------------------------------------------------------------------------------ -- - - ------ --------•-------------------•----------•-------------------------------••------------------- � _�. = ----- -- -- - ? - ------ f• F1NAL INSPECTION BY: 6? SAN JOAQUIN LOCAL HEALTH DISTRICT .k 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 1-57 F.P.CO. ,