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�\ APPLICATION FOR SANITATION PERMIT Permit No. ., (Complete in Duplicate) y .� 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 o. 549. JOB ADDRESS AND LOCATION__.__ ..... 0- Owner's Name...... //qc----------------- --------- --------------------- ---- --- ----------- Phone.......................... _,....__ Address.........�--111-•-!-••-••----•- ........ •--• •---•---•----------- Contractor's Name---- •- ------------------------------------------------ --- ---- ---- ............................... Phone -----•-- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ //Other ❑ Number of living units: _�___- ber of bedrooms ___!,�_ Number of baths 1____ Lot size ---r/--6- 1._r.2r ________ _________ Water Supply: Public system Community system[IPrivate 17lDepth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand n Gravel E] Sandy Loam E] Clay Loam ❑ Clay [] Adobe L;.-Il-ardpan ❑ Previous Application Made: Yes ❑ No ew Construction: Yes P 0 ❑ FHA/VA: Yes �;4o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 fe t.) -P, Septic T Distance from nearest well/�f_ 8_.Distance�from foundation___------Material ._.I--- --- 4V r _--•_-, No. of compartments o P �••--- ---------S,ize----/-,1_�'3---X�--Liqui�d�th #►�-------------------- Capacity...�-�Q Disposal Field: Distance from nearest well-A& -_Distance from foundation______d________Distance to nearest lot 119.1 Number of lines______ ___ Length of each line 3 5h 1 I�Width of trench._ ,_._ _// .» �"/`_______-_Total length _ Type of filter material__�a_ Depth of filter material---/ ____- g *6 Seepage Pit: Distance to nearest well_____________________Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits------- --------------Lining material.---_--------- ---Size: Diameter-----------------------Depth,--------------------------------- Cesspool: --------------_----- ---------Cesspool: Distance from nearest well-----------------Distance from foundation-------------- -----Lining material_ __-____-_____________._._-.,..__ ❑ Size: Diameter_---- _____-- -_ -Depth --------------------------------Liquid Capacity gals Privy: Distance from nearest well------------------------___ __________ _ _,Distance from nearest building............................._....... ❑ Distance to nearest lot line----------------------------- -------- ••--------•------•---------------- Remodeling and repairing (describe):__ _ -y0--�--- -• I ----------------------------•-----— -----------------------•--------•-••-----•--•----•••-•-----• •-•-•-•-- ............---------------.........................................................................---•----- 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 Local Health District. (Signed)______ ___ __ _ Owner and/or ) - ------- -e=°L'G_'�-��.,`------•----------------------------------- ------- -- -----------------------( / Contractor 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--- --- - •- •••-•-----�-----------------------•--••--•----- DATE----------- - .. REVIEWED BY DATE - ` --- ----------- BUILDING PERMIT ISSUED........... ------------------------------------------------------------------ DATE------ --; Alterations and/or recommendatio -- ---------•----•---•-• -------------------------------------------••-------•----_----•- - ... ... -----•-•- -------------- ----------------- ---------------••---•-•-•-•••••••••-•--•- .. ................... ick..... •-----!;� =G - z.�a r�rx= 3 ,yc�►. �, � - /�uposl ------ ---------- ---.................................. ---------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------•---------•-- •-•................. FINAL INSPECTION BY--------------- •---------------- Date.......... v30. r-- - •-------- ----••--- AN 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 FS-9-2M , Revised 1.57 F-P.CO.