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APPLICATiON FOR SANITATION PERMIT Permit No. .�.....��.... (Complete in Duplicate) �\ � Date Issued _�/_ .�.53 R Application is reby made to the San Joaquin Local Health District for a permit to construct and install the work her in escribed. This application is made in compliance with County!Ordinance No. 549. JOB ADDRESS AND LOCATION......t2_9..... _0' M ""---------------- �{-�— '�. • Owner's Name RRIQP��-------------1--E--F,-1.1 t Q.A-1_---------------------------- Phone------ -------- Address------------------------------------------------------C� -7----- Confractor's Name----------------------------- _rug.1.4-------�tije--------------------------------------------------------- Phone------< -"17 . Installation will serve: Residence 0( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _4--- Number of bedrooms __/-_- Number of baths __L__ Lot size --. ------------------------ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table -'left. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe � Hardpan ❑ Previous Application Made: Yes ❑ No JZ-_ New Construction: Yes 50 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wefl__/ Distance from foundation__- -_�.__-__.Material__.___ '_ _..____. No. of compartments-_-�.----------___Size__Z'"?��`_`'I- Liquid depth__. _'`..--------Capacity----fr ---------. Disposal Field: Distance from nearest well - -4VDistan eTrom foundation---.--- .Distance to nearest lot line.... Number of lines--------_-_�_...t_!R-----------Length of each line---Il� ----------------Width ofd.�`•q,, Type of filter material----/.v_.1 ,!'r1___Depth of filter material_-.--- Seepage Pit: Distance to nearest weIL .Q'. Distance f�r,gm foundafion.__.!.O.�'--.Distance to nearest lot line----------- - -- Number of pits--J----------------Lining material-!----islr� ----Size: Diameter-_.03-_'-I------Deptn._o1.5---*----------------- Cesspool: Distance from nearest well----------------- from foundation------------.-------Lining material-------.___---_.---_.-_-._-._-_---_ ❑ Size: Diameter----- --------------- ------- --------Dept f----------------------------------.-----------------Liquid Capacity-..--.------ ---------------gals. O Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__-_-...-----____._____-----..--.-..._._ ❑ Distance to nearest lot line------------------------------------------------------------------------------ ------------------------------------------------- Remodelingand/or repairing (describe):-----------------------------------------------------------•----------------------------------- --------------------------------------•- -------------- -----------------------------------------------------------••---------------•-------------••-----•-----------------•------------------------•=-------------------------------------------------------------- ---- --------- I hereby ce that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta la , and rules and re tions o the San Joaquin Local. Health District. • (Signed) •- -• - --------------------------------- - �i-/Vr,.Contractor) By: -- --------1--------rng,,� --------------------(Title)_1E22%1a_.�----------------------- (Plot plan, showing size of lot, location of syste in re on to wells, buil etc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ----------------------------------- --------------------------------------._ DATE------ ---•-------- - REVIEWED BY-------------------------------------- _ DATE- �= - . BUILDING PERMIT ISSUED._ ---------, --------------- ------- ----------------•----------- DATE------------------------- . Alterations and/or recommendations:---------- --- -- -----------------------------------------------•-----------------------------•------------•------------------------------------------------ -----.•-----------------------•--------------------•--------------------------------------------------------------------------------- ----------------------------------------------------------- -------------•------------ -------•-- -----------------------------------------------•------------------------------•--- - -----------------------------------------------------------------------------•------•--------------------------•------------- ------------------------•------•--•----• --•--•--------•------- •----------------------------------------------------------------------------------------•-- ----------- -------------------------------•------------------- ------------------------- --------- -- - -------------------------------------------------------------------- ------ - --- ------------------------------------------------------I------------------------------------------ FINAL - ---------------- 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 io-52 Revised W-2100