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C� APPLICATION FOR SANITATION` (PERMIT Permit No. (Complete in Duplicate) I Date Issued F I P 2- - t2-002- Application QZApplication 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. � /l�t�"�f e � � C�j� c� ° Le.-Y - - --1�y'•k� -1I Owner's Name ------lik, e � Phone--------- Y - Address----------------------- ------------------------------- Contractor's Name--- -r--------------------------- --------------------------------------------------------------- Phone-- . -- _,`rt�a-�__� t Installation will serve: Residence F] Apartment House F] Commercial .< Trailer Court E] Motel ElOtherA Number of living units: Number of bedrooms ________ Number of baths _______ Lot size __--- _G ----►--` _:____ Water Supply: Public system ❑ Community system [I Private [ Depth to Water Table t3t_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay E] Adobe,; Hardpan E] Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No [❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted ifpubli ic sewer ' '!able within 200 feet. Septic Tank: Distance from nearest weft __DLire from fou at: n__._ _ x No, of compartments_.______ _____________Size_____ �, i Xy _Li uid de th__�---- ._________Ca acit �I G P P Y Disposal Fi istance from nearest well--__'!_.-._Distance from foundatio{�" Distance to nearest lot lines dumber of lines___________ Length of each line-------Q__IQ---------- _.Width of trench_•__ Type of filter material-. -----Depth of filter material__/ --------Total length- w Seepage Pit: Distance to nearest well------_--------------Distance from foundation---------------.__-.Distance to nearest lot line-------.-.__-____� ❑ Number of pits----------------------Lining material---------------------.-Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material---------.---------------------------- D _._-____._______- --___. ❑ Size: Diameter--------------------=----------------Depth----------------------------------------------------Liquid Capacity---------------------------gls. Privy: Distance from nearest well_________________.______.________--------------Distance from nearest building__-__...__-_-___________.______._.______. ❑ Distance to nearest lot line R ad ling /or repairing (describ - - ------------ ` ------- an, _ -C_.-- -------- -- ---- - � ------ - -- ,,a I hereby certify t f I have prepared this application a t t the work will be done in accordance with San Joaquiny ordinances, Stat I w ,fad rugs regulati ds of the �quin Local Health District. I r ~� Owner and/or Contractor {Signe - - -------------•--- --------------------------- -- } By:._..... ----- ---- - ----- ---- ----------------------------------(Title) + (Plot plan, showing size of lot, location of syste in r ation ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ DATE ------------------ REVIEWED BY --------- --- - -------------------- DATE:: --•- , BUILDING PERMIT ISSUED----_-••-- �' - - --------------- DATE------ ---- ------ Alterations and/or recommendations: --------------------••---------------•---•------------•------------------------------------------ --------------------------•-------------------------•---•----------------------------- ------------------------------------------------------------------------------------------•---•-------- ik, ---------•----------------------•--------------------••---------------------------------------------------------------------------------•-------------------------------------------•--"-----------------------------•---- - ------------------------------------------------------------ - ------ --------------------•- ----- FINAL INSPECTION BY:_ --- ----------•---------------- Date__..-- _ � �- ._ 9 / _ ____..__. SA 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 r ES-9-2MRevise6 1-57 FRCO. j a