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APPLICATION FOR SANITATION PERMIT Permit No. Z/.dd_-1__.1.{ (Complete in Duplicate) � Date Issued----/yf� Application 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. JOBADDRESS AND LOCATION ---------------------- -------- ------------------------------------------------------------------------------------------`-------- Owner s Name---------------- "A ------------- --- . " �-•-�---------------------- --------------------------------------- I ----- Phone--- - ----------�--� Address--------------------------•------ K: ...... :------------------------------------------------------------- - Contractor's Name ------ /7Lt, jc -:f -`?-- -------------------------------------------------------------------------------- Phone-%Y`--�} j - Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ��____ Number of baths ----- I-- Lot size _____ __C'.__.a'__-__#...?_1-' � _ ----------------------•- Water Supply: Public system El- Community system ❑ Private ❑ Depth to Water Table__ ft. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel (] Sandy Loam ❑ Clay Loam -E] Clay ❑ Adobe O'Hardpan ONCI Previous Application Made: Yes ❑ No 'New Construction: Yes ❑ No E3—'FHA/VA: Yes ❑ No ❑ Z 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 ------------------------------------------------ . % e. of compartments ---------------- -----Size--------------------------- --- Liquid depth -------------------------- Capacity Disposal Field: Distance from nearest well Distance from foundation_/O__..........Distance to nearest lot line..�_f_______ �� Number of lines --------------- %------------------ Length of each line------ ______------.Width of trench. ------------------- �,� Type of filter material___�t c _ t _k._=______ Depth of filter material__J��___ ............Total length_______�___--------------- --------- Seepa"'Pit: L Distance to nearest well ------ `---------------- Distance from foundation___,/ -47__/ ------ Distance to neare-�_-__--- [11 . Number of pits______- f___--____-_ Lining material__ ---r k.i -F -- -Size: Diameter_____ 3_--_______ Dept __" U 7A_ . 44, Cesspool: Distance from nearest well ----------------- Distance from foundation_______.______.__..Lining material-_---.-_____________�►/ ____- ❑ Size: Diameter -------------------------------------- Depth ---------------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well ------------------------------------------------- Disf rrince from nearest building ___-._-________-____________.._-_._..._. ,y ❑ Distance to. nearest lot line ------------------------ --------------- -------------- ------------------------------ ------------------------ Remodeling and/or repairing {describe)._..____ ___,__�_�-�-- f • - .� _ _ ' < ... - _ `t ". L F ' --/j' ---� _ - ! — -------------------------- ----------------------- -- ! ------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- --•--------------------------------------------------------------------------- 1 hereby certify that I isa��ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ruli3s and regulations of the San Joaquin Local Health District. - T1 L) < C— --- �T 'fxr_ _---_ Owner and/or Contractor (Signed) -------------------- -------------------------1c - -' - ( ) �- By: /l t= __. '-_=------ C'- - �;•--------------------------------- (Title) -------- (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 APPLICATION ACCEPTED BY --------------- _ = - ------ -- - DATE---- --------- ---- -1 -------------- ----------------- _ REVIEWED BY ------------------------------------------- DATE --------- -- BUILDING PERMIT ISSUED ------------- -•---------- - - DATE - Alterations and/or recommendations---------------------------------------------------------------------------------- --------------------------------- s . -------f '_ ----- ------=------------- _- --------------------------------------------------------------------------------=----------------------- --------- ---------•-----r----------- -----------------------------------------=---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: ------------------------------------------ Datey - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Sfreef 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5 -9-2M Revisea 1.57 F.P.CO. dr T