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APPLICATION FOR SANITATION PERMIT Permit No" - --------------_...... (Complete in Duplicate) 1 _ Date Issuedfys S' g A plica-�ion is hereby made to the San Joaquin Local Health District for a-permit to construct and install the work herein described. -4 This application is made in compliance with County Ordinance No. 5 -- --- -- JOB ADDRESS 'ND LOCA iqN---------I------0-------_--------- T-0 ---- ---- ---&E------------------------------------------------- t Owner's Name----�/ftt-------- - -05-6-M--------------------------------------------------- ----------------- Phone----------------------------------- - - Address_____2Y.;240,_.------ _�-0---_77�4,--------- -------------------------- ----------------- ------ ------------ Contractor's Name........ -------A__�5-----_J4 V -----------------;.�--------------------------------------------------------- Phoneh-------�rgx_l--- Installation will serve: Resident VApartment House Commercial E] Trailer Court [—] Motel E] Other 0 C70 " Lot size --- ------------ /0 Number of living units: ------ Number of bedroomss.. Number of baths ./--_: -- --------------------------- --;p C�l Water Supply: Public system ❑ Community system.IL?rivate Depth to Wafer TabIe,:,?,0_. ft. Character of soil to a depth of 3 feet: Sand Gravel [] Sandy Loam F-1, Clay Loam E] Clay E] Adobe[Hardpan E] Previous Application Made: Yes E] No kNew Construction. Yes VN, [:1 .TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public jewer Fs available within 200 feet,)"., Septic ;�,ak: Distance from nearest jeh-6.67. Dista� r-,from foundation--7/......_7�m I----- C No. of compartments..... .......... -----Liq6id depiti---------- apacity-- S _--.Mated Disposal field: Distance from nea�Af well-, Distance from foundation---/6).........Distance to nearest lot RO Number of lines Le hof ik o -f each hne_15'0__ 4'd"40.Width of trench-... ------------------------- Type of filter materil filter material_ -;? _-Total length----1-96F------------- ' Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.__Distance to Cl� El Number of pits____._.- Lining material-------------------,. Size: Dept h--------------------------------- well Cesspool: Distcince-.fi-oma-earest'�'!..:� n -----------------Distance from foundation,---_.._-:_.-..__. Lining material------ ------------------------------ El Size: Diameter--------------------------------------Depth----------------------------------------------_-Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------- ------- ------------------------------Distance from nearest building_.________-_.-______________..___._____- # ❑ Distance uilding------------------------------------------ Distanceto nearest lot line----------------------------- ----------------- ----------------------------------------------------------------------------------------- Remodelingand/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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----------------------------------------------------------------------------------------------------------------------------------------------------------------(Owner and/or Contractor) By----------------------------------------------------------------------------------------------------------------------=----------(Title)------------------- --------------------------- ----- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FRR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- BY----------- -------------------------------------------------•---- —----- DATE---------- -----r---A -----------9------------------------------------------------------- - REVIEWED BY----------------------'------------------ ---- DATE d---BUILDING PERMIT ISSUEb :-------------------- ---------------------------- ------------------ DATE_ Alterations and/or recommendations:------ ----- --------------------------------------------------------I—-----------------------------• ------------------------------------------------------------------------------------------ - ------- ---- ---------------------- ----------- ----- ---------------------------- ------------------ - -------------- ---------------------------- ----- - - 71-------------------------------- ------------ --------------------------------------- ------- ...... - -------------------_----- .. -------- ------------- ------ ------------ ------------------------------------------ -------------------------- ----- V —2 -CTIO h ------------------------- -------------------------------------- FINAL INSPE N 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 145446 ATW3DD