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APPLICATION FOR SANITATION PERMIT Permit No. ._.. _ �— �5.. (Complete in Duplicate) y� Date Issued ?__-__ 4� 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 Ord' nce f� CAI IV-&I JOB ADDRESS AND LOCATION-----------�SS--------�V'- 7n ,5✓' ]].... -------------------- ------------- -•- -------- Phone., ..._ Owner's Name ------------�n.C�"? '�et !=` � w - •----•--- � a�iry� Address-----------•------0/4 �► L'� ...._ 'CJ,A./_" ==T' ------------- ------ Contractor's Name-----------------------------0,-40.n/�/G----- 0. G "�•2A_0'_T`_ Phone.. . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: J___ Number of bedrooms --!Z�Number of baths __/___ Lot size __-__4�1 Ad..___-X..____,j':',�.�'� � Water Supply: Publics stem [Community system ❑ Private E] Depth to Water Table _,_.___ ft.� Y y Character of soil to a depth of 3.feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe�arclpan [) Previous Application Made: Yes ❑ No Ur""New Construction: Yes !J'lNo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: --, (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) , Septic T nk: Distance from nearest well_ /freDistance from foundation__ -tV------Material_.�4�1 _:_ Et.Q..,f�_.... No. of compartments- --__ z -----------Size_9_ _1 sC:. Liquid depth---- _Capacity Dispos Field: Distance from nearest well----A l Distance from foundation___AV../....Distance to nearest lot line_ ......... Number of lines_____________ .. ________Length of each line..........�Q -- -----Width of trench APAP-44r Type of filter material_____Ar—At.Depth of filter material______I _____---Total length__..___.__l_- !7__.___............ Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest Jot line-----;.__-_-_--._ ❑ Number of pits______ _____________Lining material-----------------------Size: Diameter-----------------------Depth.--------------....... ,____•__• Cesspool: Distance from nearest well __________Distance from foundation _____ Lining material_ ❑ Size: Diameter-------------------------- ----•--Depth---- ----------------------------------- ------Liquid Capacity............................9 al Privy: Distance from nearest well_________ ___________ _ ____, -____-_Distance from nearest building-----------------------------............ ❑ Distance to nearest lot line------------------- - ----- - -.----- -_----- ------- -•------ ---------------_--................. Remodeling and/or repairing (describe:-____ - __ -------- - - - - ---------.ro-! ------- =------ -' ....... x.3.3 =' -� --- ---- -- ------------------------------ ------------------------------------ ---- - ------------ ------------- ----------------------------------- --------------- --- ---. I hereby certify that I have prepared this application and that the work will be done in accefd ce wit San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. _ ----------------------------------------------(Owner and/or Contractor) (Signed --- -- ------------------ -------`- --�'--- - ----------- --'-=-�- -------- ----------...------------------- ------------------ 8y------------------------- ------------•--- •-••-----------•----- ---•--------------------------•------------•-------------------(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--------- --- Al ------ ----- ----- ----------------------------------- DATE �5 REVIEWED BY----- ------------------- ---------- --- -------------- -------------- •-------------•-------- DATE------.-------- --• • -------•---- BUILDINGPERMIT ISSUED--------•••--- --- -------------------------------------------____----------------------• DATE---------- ,�---- ----------------------- --.•-- Alterations and/or recommendations: ----------- ----------------------------------------------•---------•--------•--------------------------------•-•••--••-•-•------•---•--- - ----- ------ :Lz:------- ---• --------------- ----------------------------------------•---•--•--------------•--•-••••-•--••---••-••••••----••-•---•------•------•---•••••••---•-•- ---------- r ---------------•-----------------------•-•----•-----------------••----•--•---•---••--•--•-----------................... r-� Xl-�Jvvle .... I? X� I FINAL INSPECTION BY:------- ------ -- f - `.. -- ----- Date-- .��----- ----- - 40, SAN V 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 ES-9-2M Revised 1-57 F.P.CO_