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tom- G I r sb Permit No. - G Z E APPLICATION FOR SANITATION PERMIT --- (Complete in Duplicate) .- 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. ; This application is made in compliance with County Ordinance No. 549. J ---------•-------------------------------------------------- JOB ADDRESS AND LOCATION_y__�_�-C)--�-------- ' �--_- �f--/�----------- Q--e----------- �1J .. _G S_S --------------- ----------- - ----------- ' Phone �• Owner's Name-------- _.. ' Address-----_---- ...... ----------------•----------------------------------------------------•----- Phone---------------•------------------- Contractor's Name.. lS � ------ Installation will serve: Residence k"'A artment House ❑ Commercial ❑ Trailer Court [3 Motel ❑ Other P r Number of living units: _/--_;Number of bedrooms -_--ZrNumber of baths .---e�- Lot size ___________________..__.___._.-----_---- -------•----------- Water Supply: Public system [Community system El Priv El Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--Hardpan ❑ Previous Application Made: Yes ❑ No ®--*'-New Construction: Yes E4--lqo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:` j� Distance from nearest well-----------------Distance from foundation------------- Material--.----_----.____-------.-.-_--------._____-.--- ❑�a,l/rjr�r / No. of compartments------ ------------------Size---------- ------------- ------Liquid depth.---------------- --------Capacity----------------------- Disposal Field:jj .yDistance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line____----_-.-____ ❑ �rJ1 ' /Number of lines------------------------- -------Length of each line------------'-'------'--'-' Width of trench---------'------------'------------ Type of filter material-------------------------Depth of 'filter material-.--..------------ -i-Total length____-.._-_-_- ._.-___----' .-..•.. SeepageFit: Distance to nearest well_./!la_/1/'-G-Distance from foundation-----..__�_.__.Distance to nearest of �n�_____-_ - �.��._._.Depth''-- ' Number of pits--------- ------------Lining materiall'f-C.K.-----Size: Diameter._....-- \ - Cesspool: Distance fromrnearest well-----------------Distance from foundation__..-------------- Lining material------------------------------------Size: Diameter ---- ----Depth--' . --------' ------Liquid Capacity-- -------------------------gals. ---------------- ' G Privy: Distance from nearest well---- ___..___..._ ------------------------- -Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line........ ' ` ! 1 ° -- llr_ ''f------------------- - Remodeling and/or repairing {de3crrbe): ---- -•----------------- ---------------------------- -1-------- --------••----- - -- - - ---------- -- - - ---- -•- - -•------•-•-------------------------------------•----------------------•----- --- ---------------•-•--------------- ---------------- here- -by- -- - -- certify th-at----- -- I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the San Joaquin Local Health District. Sr ned fl f�,f�� /C + er and/or Contractor) �9 --'-- - ------ -'--- - ------ - ------------------- ------------ A - ------ (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 DATE-'---. `! 7*.4 APPLICATION ACCEPTED BY... rte' 1 ----------------------------------------------------- DATE----)- REVIEWED BY------------------------------ '' WA BUILDING PERMIT ISSUED-------_---_:�- -' - ------------ DATE. � � Alto tions and/or recommendations: --------------------------------•---------------•--- , , . � � ------------------ ------------•---------------------.------------------•------ --•------ I --- •------ ---------------------- ----------' ION BY:._"1� ----' --'-- --- ------ 0__----•----- Datef ------ --------------- FINAL INSPECT SAN JOAQUIN LOCAL HEALTH DISTRICT t 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California EL—g 14-46 A'WDDo