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APPLICATION FOR SANITATION PERMIT Permit No. ..U�-7_ �� (Complete in Duplicate) Date Issued -------f _._1 Applica--ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. k This application is made in compliance with County Ordinance No, 549. - -----=-----------v----------------------------------------------------------------- JOB ADDRESS AND__LOCATION_ ._._C✓1_�� _e _.= _ Phone.----------------------------------- Owner's Name------- -,:-•---._ Address--•--•., -------- -� /V__4!?,_ ------- ----------------------------- Contractors Name.....: .. .. 1_34 � --------------------- Phone { 4f� . ...� ---- Installation will serve: •Residence �j Apartment House ❑ Commercial ❑ Trailer Court [) M tel [❑ Other ❑ Number of living units: _. ____ Number of bedrooms ___,Z Number of baths ___!_-_- Lot size -------- t___ �__ _ _________________ Wafer Supply: Publicisyatem Community system'❑ Private ❑ Depth to Wafer Table _off. : Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [q Hardpan.❑ i ! Previous Application Made: Yes ❑ No X New Construction: Yes 2L No ❑ { TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----- from foundation------lam-------Material--- _______ ____ 171 No. of compartments____.___- Size--_., __ ------Liquid depth-------6�1............Capacity____ Disposal Field: Distance from nearest well_/44A�Distance from founclation�___1,.�.,_Distance to nearest lot line.,______ (KINumber of lines____________._//.1.._-- -Length of each line________..`6----.-----Width of trench___.__�_�___________________ Type of filter material__-,1r_..S 71�.t.`Depth'of filter'material__:__ Total length--------- s?__________________________ p 5 undation_---__________ .Disse to nearest lot li See�a e Pit: I�lumaber of pts nearest we ! L�ing__mDt rale from fo_� ize: Diameter----.V----------------Depfh----_-�� ---_------- t ' 9J1•c t 1 Cesspool: Distance from nearest well-----------------:Distance from foundation---------------------Lining material------------------------------------- El Size: Diameter-------------------------- -- Dept, - -- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------_. t.-__------ ---------------------Distance from nearest building--------------------------------------- -- " " Distance to-nearest'lot-line_w___-_.__:' "":_"`_ -- - r 4� i Remodeling and/or re;pairing ( --------------------------------------------- ------------••--------•----- ----------•-------•------------------------------------ describe}:___ _____ _._--------------_ .� i } ••------- ------------------- ----------------•---------i•------------•-------------r--------------------------------------------- ------------------------------------------------ • t --------•----•-----------------------------------------------•------------•-------------•--•---•-------------------------------------------------------- I hereby certify that I have prepared this -application and that the work will be done'in accordance with San Joaquin County ordinances, Stat s, and rules and regulations of the San Joaquin Local Health District. 1 1 t ��(SignedB------------- - �...--� --I-?- ✓-- --r- ---- -- -- ------- -- •- --=-----------------------------I----------- _------O ner and/or Contractor] •------------ •-•------- ------ ------ ------:- -- - - -�iwtZ--------------------------------------------(Title)------- ----------------------------------- (Plot --•---•-------- ------;----------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). � s ' FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY------------- ----- ---- - --------------------------------------------------------- DATE__" -...--••--------------------- --------------------- REVIEWED ------ ----- REVIEWED BY----------------------------------- - O ----------- --• - ------ -------------------------- ---•- ----------------------------------- DAT .._ _ .._;:::;-----------------------------------•----- BUILDING PERMIT ISSUED - --------------= DATE. :-------------- .................. Alterations and/or recommendations:-------------------- ----- -=------------=-------------- -•---------------•---------------------- - `-- ----------------------------------- ��' ----- �--------------------------------------------- - „ -------------------------------------------- -------•---------------- ----------------------- ---------------------------6----------- -----------------�: ----------•------------------------ -------------•--i_ - ---------------- ------- ------------------- -------------------- FINAL INSPECTION 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 E5-9-2M Revised W-2100