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M APPLICATION FOR SANITATION PERMIT Permit No. `�_.O 3 S (Complete in Duplicate) �e4 Date Issued Applica ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with County Ordinance IjoD. 549. JOB ADDRESS A!�LOCATION_ ------- -- ---- -- -------- --------•---------------------------------------------- ---------------Owner's Name .,�,`s'-r�G- .`:`... ,.__._--__-.- Phone. --- C0' _ Address. a-t,�{ ,Q. ---------------- -----------------------------------------------------------------------------..................................... Contractor's Name >------------------------------------------------------------------------------------ Phone - ,,1 Installation will serve: Residence,K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-___ Number of bedrooms,. Number of baths ._Z. Lot size _.,/ '� .�r �.....__________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table'- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No,Ko" New Construction: Yes ❑ Nolo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) /S-eptic Tank: Distance from nearest well_________________Distance from foundation--------_-_-_-..._ l _ -----------Material ,=*4 4 V�flNo. of compartments--------------------------Size---------------•----------------Liquid depth--------------- ----- ----Capacity----------------------- Disposal Field:(/ Distance from nearest well------------------Distance from foundation--_-___-.___-_---_-.Distance to nearest lot line._____._____.:._. �,,,w,� Number of lines___________________•---------------Length of each line.._..___.._____._.__..__..___.Width of french----------- Type of filter material----- Depth of filter material-------------__--------Total length_-_______-____-_____-_-_•.-_•___________.. Seepage Pit: Distance to nearest well_ _----Distance f m fou ation_...,jG._�__:Ristance to nearest lot line---- Number of pits___.___-___-______-Lining materi Size: Diameter___._!-.._--__-.-_Depth__._,O��_/---------------- 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--- ---------it----------------------------------------------•--------------------------- Remodeling and/or repairing (describe):----- I -Ioolz__�_Pl------------------------------------------------------------------------------------------------------------------------- --------------------------------------- -------------------------------------------------------------------------------------------------•---------------•--------•--------------------_-----•-------------.---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rule and regul ions of the San Joaquin Local Health District. (Signed)......... --- ---- -- . ------ ----'----------------------------------------------------- (Owner and/yr ntractor) ---------------------------------------------------Ti+le (Plot plan, showin a of lot, Iocation of system in relation to wells, buildings, etc., can be pl on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B --------------------------------------------------------------------------------- DATE REVIEWEDBY------------------ ------ --- ------------------------------------------------------- ------ DATE-- •--.... .........------------------------------- BUILDINGPERMIT ISSUED------------------------------------------ ----------------------------------------------------------- DATE--------L.?'------------------------------------------------ Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- -60:�� ' , -•--------------------------- - - ------ ---------- -------------------------------------•---------------------------------------------------- --------- --••-- -- �- /. FINAL INSPECTION BY:............ ------- ------ - Date------ ------- / --------------------- SAN 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 10-52 Revised W-2100