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vy/ 1 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) , Date Issued _1lA Application is hereby-ma'd`e to the San Joaquin Local Health District for a permit to construct and install the work herein described. k This application is made in compliance with County Ordinance No. 549. 1 " -_-----;__ -------------�---- --- - - -� ,_____JOB ADDRESS AND LOCATION _ - a -------- Phone ----------- Owner s N _ -------------------------•------ , --•---•------ ' I� Address Phone f,� Contractor's Name- k�- ------------------ ""----- ---;� C� � ?= ---------------- ------------------- lnstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court, ❑`1' Motel ❑ Other ❑ 'r 1 -'�� --fj— ------- Number of living units: __- ____ Number of bedrooms __---- Number of:baths �-'-_ Lot sue ______ -1. " --- } Water Supply: Public system ❑Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam El Clay Loam El Clay F] Adobe❑Hdpan ❑ ar �` New Construction:Yes ❑-1 Tt❑` FHA/VA: Yes ❑, No 5..Previous Application Made: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank:-'r , Distance from nearest well-----------------Distance from foundation-------------------.Material---------Ca acit " -x---�:f-�� No of compartments---------------- ----------Size--------------------------------Liquid dh ep !-------- ----'------ -- p y-----------------= - f 't 4� Disposal Field: .Distance from nearest well------_-----------Distance from foundation-----.--------.____.Distance to nearest lot line---------------- s , Mumber of lines-----------------------------------Length of each line------------------------------_ _ Vdidth of trent .----------------------- ------- Type of filter material------------------------- of filter material_ .__-________________Total length___-.___.______-______.__- P___,_-""-- Seepage Pit: Distance to nearest well---- N----Distance from foundation_ _____._.___.Dtan�fe�to nearest lot iine__�-------------- Number of its----- _Lining material---Y 'Y._.~�---Size: Diamete"r____- r"---- Depth------ - Cesspool: Distance from nearest-well-----------------Distance from foundation--------------------Lining material-----------------------------------ls.-' (11 ElSize: Diameter--------------- ---------------------Depth----------------------- ---------------------------Liquid Capacity----------------------------ga I* ____,-_""---._Distance.from nearest building------------------------------------------ Privy: Distance from nearest well---------------------------------- ❑ Distance to nearest lot line--------------------------------------- - - I --- Remodeling and/or repairing describe -------------" - �^ l ---. ---- -----------------•-----------------.- ------_"-- --------------------------------------------------------------- --- - --------------•- --------•---•-------------- ------------------------- ---- ------- ------- 1 ---- -------------.----------- --------------- ------------------------------------------------------------------------------------------------------------------------------- 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 ---------------------- '.- 1 C:- -`,-/ �f c`� --------------------------------------------------(Owner and/or Contractor) -- - /V!-Jr- -�------ �-------(Title)-------� (Plot plan, showing sae of lot, location of system in relation to wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY -----------•---------------------" DATE.�-•e--------------------------------- APPLICATION ACCEPTED BY ------ DATE---�---------•-------------------=-----"------------ REVIEWED BYE---------- ------- --------------------------------------------------- ------•- ------------------------'- BUILDING PERMIT ISSUE _________________________"_-.- ------------------------------•-------- ------ DATE 4 , !. Alterations and/or recommendations----------------------------------- - -- ------- ----•----•---------------•---------------------- e�-�y , - ___ ___________ - ---------------------------- -------------------------------------- _. ____-__- _____________________________________________________________ ----- - ___jyj f ((f � ______ FINAL INSPECTION BY..-___ - SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S eamore Street 814 North "C" Street 130 South American Stree+ 300 West Oak Street Y Lodi, California Manteca, California Tracy, California 4 Stockton, California l � ES-9-2 M Revised 1.57 f.P,CO. Vii'