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• �" �/ll ' APPLICATION FOR SANITATION PERMIT j � Permit No. ___��-______ (Complete in Duplicate) Date Issued --_q19A - r 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 Ordinan e No. 549. • � jj f JOBADDRESS AND LOCATION , ------------- j ---- �,ej-_15---------------------=----------- 11 ------------------------------------------------- Owner's Name -Ts- 7 A I� U'= > t%� ; _.; -- Phone ------------------------------------ Address----------- •------•------- -------------------------------------------------------------I -�-1-'------ --------------------- 1 Contractor's Name ------------------------- --------------------- Phone...- - Installation will serve: Residence Apartment House ❑ Commercial .,;❑ Trailer Court ❑ IMofel ❑ Other ❑ Nuri�ber of living units: __I__- Number of bedrooms _: Number,. of baths__. ____ Lot size _t* �Q------------------------- ommunit system Private NDe' --twater Table .�a Water Supply: Public system /� Community y ❑ � ❑ P �..._�.-� Character of soil to a depth of 3 feet: Sand ❑ Gravel E]? Sandy Loam ❑ Clay Loam [I-. Clay}[] Adobelk Hardpan p ' Previous Application Made: YesNo E]New C nstruction: Yes'�No ❑ FHA/VA; Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1. ' A i (No septic tank or` cesspool permitted if public Xisfa;ce er is available within 200 feet.) A. Septic Tank: Distance from nearest well ?_W__from foundation --_i_ b._":__ �___.MaLt Iial___ __ _ _ __ _______ ______________- No. of compartments------------ - ------Size---/'�'' id d pth____--'/-!_--_-_--Capacity---Ia---� Disposal Field: Distance from nearest well AQRDistance from foundation__��______.'._. 'stance{ to nearest lot line- �(./_______ Number of lines____ __.____ Length of each line___ �—i ` "_ idyh of trench .___-�_y_ ________________ �7 - Type of filter material__v4Ci______-_ Depth of filter material-_ _ _ `f _ - 1 Total'�le�gth______ __ C____________________11 - p �� ( ) {� Seepage Pit: Distance to nearest well _____________________Distance from foundation _-:..._____....__..Distance,to nearest lot line_-.________._____ ❑ Number of pits ----------------------Lining material ----------------------- Size: Diameter ---------,�_.E-------- Depth ------------- --- r Cesspool: Distance from nearest well_______________Distance from foundation -------------- material ------------------------ -------------- "fit El Size: Diameter--------------- _ ---------------------- Depth ----------------------------- ------------------LiquidiCapacity----------------------------gals. t_______ -_----Distance from nearest buildin � Privy: Distance from nearest well ---------------------------------__ g----------------------- �----------------� ❑ Distance to nearest lot line--------- -------------------------------------- --------------------------------------------------- --------------------------------------- ----- -------------------------------------- • E R eling and/or repairing (describ I --------•---- -- ----- zl-------- --- ----- - 1 ---------------- /-�- - ---------------------- ------------ ------- j---- ------ - I hereby certify that I have prepared this application and that'the work will be done in accordance with San Joaquin County rdinances, State laws, and rules and re la+ions of the San Joaquin Local Health District. 1 ----------- -------------- (Signed) (Owner and/or Contractor) E�� Title--------------------------------------------------------------- (Plot ---------------(Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ----------------------- ------- I --------------------------------------------- DATE---- ` REVIEWED BY--------------------------------- D-ATE Z= - BUILDING PERMIT ISSUED---------------- ---- --- - ------------------------------------------ DATE.------- ----------- - Alterations and/or recommendations---------------P----------------------------------------_----------- 1 •• -- ------------------------------•----•-------- -------•------------------- I------------- ------- 2 FINAL INSPECTION BY:.- Date----------- 0 ----------------------------- SAN OAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M , Revisea )-57 F.P.CO.