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APPLICATION FOR SANITATION PERMIT Permit No. _.-.f?...l.. r_Z (Complete in Duplicate) Date Issued ---///r �/ C�,0-0/ Applica+ion 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. � � ,,, /fi Ar". � 2.?(4 3'9 9 4-•t",0,17--w.4- JOB ADDRESS AND LOCATION Owner's Name------------ r- r... r � ------------- ----------- Phone--------------------------------- Address-------------------•-----•----.r � s~x' C} .:/ ;f` Q' -------------------- Contractor's Name-------------------------------------------------------------------------------------- •-------- Phone----------------------------------- Installation .---- ------Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M ❑ Other ❑ Number of living units: _-.f--- Number of bedrooms.---- Number of baths __�--- Lot size __-'_-Z19v------------------ --------- Wafer -�__.___._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water TableM . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam r""Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ �No Ej ."'New Construction: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet Septic nk: Distance from nearest well__S0'_-?t!atDistanc from foundation-- ------------Mate iaL $�" '___--:-••______-____-__--_- No, of Compartments..___ r-.-----.____Size- -- _ _ Liquid depth________ --------Capacity--� -----------_ j Disposal Field: Distance from nearest well--,P_ _Distance from foundation__•R_-�----------.Distance to nearest lot Number of lines-------- ._____ _ Length of each line- �� ._`7� ..�------.Width of trench-_.A_ �"----------_-.---- Type of filter material--- -Depth of filter material_-f�" -----Total length----- *f Seepage Pit: Distance to nearest well-----_----------------Distance from foundation------------------- Distance to nearest lot line_-----.----.---_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------- -----Depth-----------------------------•__- Cesspool: Distance from nearest well-----------------Distance from foundation--- -------.-------- ining material-_-----------------------____------_. ❑ _. . ..�5ize;-D.iamater-_.---.,r------ __— Depth-------------------------------- -------------------Liquid Capacity -------gals. Privy: Distance from nearest well---.___._------------------------------------.____Distance from nearest building-*�=�__.- —__•_: _.�•A_. ❑ Distance to nearest lot line----- --------------------- Remodeling and/or repairing (describe):--------- ------ - ------------- -----------------•---------------------------.--------- ----------•---------------•------•------------•----------•----•---•-•--------------------------•---••---•----------••------------•----------------------------------•------------------•------------------------------- -------------- ---- -------------------------------------------------------------•---•------------------------•-•---------------------------------------•- ------------------••----------------------------------- 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. _^-c.-t (Signed)----- - ---- - --- _---_ •----- ----------- ------- ---------------------------------------------- --------(Owner and/or Contractor) . BY: 6 -------------------------------------------------------------------------------------------------------(Title)--------------------------------------------- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORD ARTMENT U ONLY APPLICATION ACCEPTED DATE_ REVIEWED REVIEWED BY - - - - ------------------------------- •-------- DATE----- ------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------- ---------------- Alterations and/or recommendations:-------------------- - ----------------------------------------------------- ---------------------------------------------- ----------- -•----------------------------------•--------- ------ --------------------------- -------- -------------------------------------------------------------------------------------------------•----------••- ------------------------------- FINAL'-INSPECTION BY-------- -------- ---- ---- -------------------------- Date..—cam: t SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton„Co;ifo nie r' Lodi, California Manteca, California Tracy, California "4 ES*9-2M n54a6,aTw[{{)o-- i`d1 4