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��,�\ APPL1CATlON FOR SANITATION PERMIT Permit No. ___--_ �-��? I b M (Complete in Duplicate) Date Issued .____!_ h ?Applica4-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 Com Ordinance No. 549. JOB ADDRESS AND OCATEON___. _4 -----------.-`a--------- _ _ ------ -�----------------------- Phone--- ----- •---- -------------------------- ---------------•---------- Owner's Name--------- - Address---------------------- Contractor's Name_________________________ -----------•--------------•---------•------- -------------------------------••-------- -------------••-----------•---- ------=------------------------------•---- -------- - - Installation will serve: Residence �(Apartmenf House ❑ Commercial ❑ Trailer Court ❑ �M �❑ Other Number of living units: __r___ Number of bedrooms .-- Number of baths ---/--- Lot size ______1__ — ___________ ----____ _______________________ ��/Deth to-Water Table Water Supply: Public system F1 Community Community system ❑ L1 p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ . Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 1 Ch � - Previous Application Made: Yes ❑ No � New Construction: Yes [�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ewer is available within 200 feet`.) ,f______.Mate ia4 -------- ---------------------- ------------ - Septic T trk: Distance from nearest well____ ____-_.___Distan e from fou dation____._ - f Capacity ��4__ No. of compartments----------- `=.__Size__ j_X-- ------Liquid depth------------------ - p Y f Dispose Field: Distance from nearesi well----Y _____Distance from foundation______- _________,Distance to nearest- lot line________________ Number of lines--------- ------- -----"-••--------Length of each line------------------------------Width of trench--__:_-- ^'------------------- Number - -�------------ rt Type of filter material___ � q?_ _I�{Depth of filter material....-"___/_�-'____Total length-"_________ '__ ------------------ Seepage Pit: Distance to nearest well_________ _________ Distance rest lot line___________._____ from foundation___-.______-___-___.Distance to nea Number of pits.--------- -------Lining material---------- ------------Size- Diameter---------- -----------..Dept{n------------------------------- ing Cesspool: Distance from nearest well_________________Distance.from•foundation"__________-"-- -Linuid Capacity gals. y� ----------Depth----- q p tY---------------------------- l� ❑ Size: Diameter----- ---------- -"---- -=------ ------------ ------_----- Privy: Distance from nearest well--------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot- ine.___.---------------------- -- ------------•---------------------"- 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, S to laws, and rule and regulations of the San Joaquin Local Health District. (Sign �'�sP'j". (1 ------------------_______.____..___----(Owner and/or Contractor( Title By:-------•--------------`----------•----------- ------- -------- ------ ( } (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 2-------------- = REVIEWEDBY------------------------ ------ - DATE----- -!'---e-I---------..-.--•------------------- BUILDING PERMIT ISSUED--------_-------------- ------ -�--=------------ --------••---------------• - --•--- DATE------- ----------------- Alterations and/or recommendations:.____--- ,------ ---------- --- 7 �/1�- —r� ,�- ------------ ---------------------------- c /mac--------- �-- --°`� -- ---- ----------�_`=f�:._s,�------�-- ---------------------- -----�I- --------------------------------------------------------- ------------------------- -- ------- ------------- .........--- ------- ---------- --- _ ------- -------------------------------------------------------------------- --------- ----------- ---------------------- ----------- ------------ --- ------------------ - s' --------------------- FINAL INSPECTION BY:--------------------------------------�-------------•----- Date----- Q---•------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wert Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y.