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N APPLICATION FOR SANITATION PERMIT Permit No. __s Jr (Complete in Duplicate) `J 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 LOCATION--,. yQ_-___-- --------•------------------------ ----------------------•---------•------------ Owner's Name------------ - Phone--).VL.-o ' I-- — '� ---------- ----------- -- - -- ----- ------------------------------------------------ -. Address 1� a cru-4iJ - e..--------------------------------•--•----------- -----------------f fJ _ --------------------------------------------------------------------•--- Contractor's Name -----� -i-�rc.- , i Phone- Contractor's Installation will serve: Residence (A part(n Hou se❑ - Commerp�ial`'❑ Trailer aunt, ❑ Motel ❑ Other ❑ # Number'of living units. l-__-y Numb'er,of bedrooms _-_ .Number of baths __/_ Lot size ------- x�-. - ------------------------ Water Supply: Public system D�ommunity system ❑ Private ❑ Depth"to Wate)Table . o ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑Clay Loam E] Clay ❑ Adobe HardpanEl i, r Previous Application Made: Yes E-] . No [ ��.Nbww Construction: Y '�'�I�o El TYPE OF INSTALLATION AND SPECIF16ATIONS: (No septic tank or cesspool permitted if pubi)ic sewer'iravailab1'e within 200 feet.)t Septic Tank: Distance from nearest�well�'�_Distance from,foundationD-----_-_Material___ '_ '-- ----------------- No. of compartments_.!---- --------------Size. ------Liquid depth--:--4� -.A..--_.Capacity----$'SD-------- Disposal eld: Distance from nearest+we11. -Distance from foundation---Zd.1______.Distance to nearest lot Number of lines----t----- _ g :;!--V A r-Len th of each line______�a______�..___...Width of +rench_.____ ._�_'______________. _ ot,filter material__-S.!- r7�a__ _Depth of filter, material______ g -�------------------------------- Type t�`-_.__Total length.P 4 Seepage f: Distance to nearest well_-�--�.-_.___�_1-e_ 1^Di Lance from�foundation.....14.___....Distance to nearest lot line---.S_�______. Number of pits-----/_ __------_Lrning mater�al_ !_r- µ.5ize: Diameter33 Depfh_.__-2_ ______________.-__- . * 4 Cesspool: Distance from nearest well-----------____Dir#ante from foundation------. -_-_:----.Lining material---_---------..____-_______._-_--___ ❑ Size: Diameter----- -----------------------)------.De th-------------- ---- Ul Depth -------------------------Liquid CapacitY---------- ------------,--gals. Privy: : Distance Brom nearest well__.___ ______________________________________Distance from nearer# building__---------------------------------------- d I Distance to nearest lot line------------------------- Remodeling and/or repairing (describe) ----- --- - -------- - --------- -----------•----------•----------•----------------------------..._ . . ------------•-----------------------------•-------•---•----------------------------------------------------•----------------------------------------•-------------------•-------------•-••------------------------ ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to Iaws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- _ --- ------------------•------------------------------------------------ ------------------ti ------------------ - % - - - ------- ---- -------------------- - -Owner end/or Contractor � -- -------------- By: {Title - _ (Plot plan, showing size of lot, location of system in relafyo`n to wells, buildings, etc., can be placed on reverse side). , V , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -----------------_------------------------------------------- DATE---------- 'r r REVIEWED BY ---------------------- DATE- = t BUILDING PERMIT ISSUED ----------------------------------- = -- ------ DATE Alterations and/or recommendations:- 1------------------------------------ --------------------•-------------------------'-----•----•------------- I , --- ------------------•------------=----------------------------------- ----------------------------------------------------------------•-----------•-•------ -------------- -------------- -----•----------------------------- ----------------------------- ------------- --------------------- ------------------------------•-- ••---------------------•------------------------------------------------•---•--•-- . ------------------------------------------------------I----•------------------------..-----•----------------------...- -------------- ---------------------...-•------------------------------------------------ ------------------------- • ------------------------------------------------------------------------------------------ } FINAL INSPECTION BY:.--------- ---------------------------------- Date-------- ------ SAN ----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 Revised W-2100