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APPLICATION FOR SANITATION PERMIT Permit No. (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. JOB ADDRESS AND OCATION---• ---- -- ------P042--,----------__- -------------------------------------------------------- /� Owners Name /_�L!_ Li%►•-r Phone------------------------------------ Address---------- .?--,;2-- ---- �= ! ---•--•----• --••-----•--- -----------------:--------------------- iY , A Contractors Name. ..__. . "------------ -------------------- Phone-, .![�''� [1.7_ -------------------------- Installation will serve: Residence E. Apartment Hous(P[ Comm.ercialm)<❑ Trailer Court [I Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms ___-Number of baths ----/-- Lot size .--------------------- ` / -- Water Supply: Public system"Community system ❑ P d ate F] Depth to Water Table -d.6 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [A New Construction: Yes ❑ No Ea TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r , Sepfic Tank: Distance from nearest well__,.�C7�.Distance from foundation_-.-__�- --.__Material_-- - --� y! .---_------- No. of compartments---- -- Siie---�? --X-. __Liquid depth----- Capacity---- U-L�---- -� istance from nearest well ------Distance from foundation -__ r• �� Qisposal Field: � � .._. /1�_ w__-._..Qistance to nearest lot line__________ ____ 0 #'-7-7-.pp4t,'��W-Mber of lines--:I-'------------I-=---------�.----Length,of each Gne-:- - - -.----.-.Width of trench---- -'7`-------------------•-- He.-6C,-IType of filter n-iaterial--_ _----__-----L_/bepth of filter material----------- :______._Total length_________ _______________________________ f min m f 1 Seepage Pit: Distance to nearest well.-.��f�bx^�•-- Distance from foundation____l�________.Distance to nearest lot Ime_^__-._�'____ N � ® Number o pits_,_... _ Lining 4aterial-_.�°=_ 4. ize: Diameter-.31_.____-__.Dep#h___ �___________________ Cesspool: Distance fromnearest well------------------ F1 from'foundation.____________------Lining material--------------------- /Q - ' ----------- Size: Diameter + S __--_-- Liquid Capacity y• t __�.Depthr---------�------=-•_----•----- ---� ----- q ------------•- ---------••--gals. Privy: Distance from nearest well-___. ----------f_-----------__ r Distance from nearest building._ t.tt - ❑ Distance to nearest lot line..:.---------------- ---------------------------------y-------------------------------------------------------------------- Remodeling and or repairing (describe]________ _____ ._:_ -sr-E --+_-^-__'l � ______________________ - - ----- 9 ------------------------------------------- ------------------------------- --____�_._t_.___:--------------------------'•---••----------I--•--- -------------••-•- •---•----- --------------------•-----------•---•--•--I- ------------------•-•---------------------=----___-------_____----•-----•-----------•---------------------------------------------------------------- 1 I hereby certify That I have prepared:this application and that the work will be done ini accordance with San Joaquin County ordinances, SfafeAI ws, and rules and"regulations of the.San Joaquin Local Health District. (Signed)--------- —�� [!: � ~`""�� __- _--- ----------------(Owner and/or Contractor) I I _ (rifle ----- ---------- (Plot plan, showing size of lot, location of system in relation to wel[s, buildings, etc., can be placed on reverse side). # FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------ DATE------------------------------------------------------------ REVIEWED BY - - - `�' _ DATE-�. .. _..-- ------- - ------------- -- --------- --- __-- BUILDING PERMIT ISSUED Q TE--- - ----- -------------- ! Alterations a5d/or recommendations: -----. C. --• - n- .--------- b i a+ ------------ .. ---------------------- ----------------------------•-----•--•-------------•----------•-------------------------•-------------------------------------------------•------------------------------- --- . I -----•--------------------------------------•-•-------------•--------••----------------•------------------------------------------------------------------------------------------------------------------------ .......... - ------------------------------------ ----------------- --------------- ------ --- ------- - --------------- --•------------------------------------•----------:------------------------------------•------•---------------- FINAL INSPECTION BY: Date....��-.':--: C"j----�� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North\ Stockton, California Lodi, California Manteca, California Tracy, Cal ES-9-2M 195446 ATWnnO 12-S4 ,