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r 1 '° APPLICATION FOR SANITATION PERMIT Permit No. - (Complete in Duplicate) fiy �g --- . Date Issued --_-- ___---•-_--f Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance Nn. 549. JOB ADDRESS AND LOCATION---------ISO--�---------------------•--------------------------- ------------------------------- -- - --------------------------------------- Owner's Name---------------------TO------6------ --------------•------------ - Phone------------------------------------- - ----------------------- i 1p�/^ /�r)---- �-----------�1" ---fes.-�----------------------- ----------- •� 1.- � 1 'y - •-- , Cont actors Name --- --- _ _a._ ---•--- �7�-�a.`— - = btu r ' = ----------------- Phone --------------- 1 -- a. { Installation will-serve:' Residences Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other.[] a _ . Number of living units: I----- Number of bedrooms__. Number._of'baths /_jt:-Lot size ______/_kX/ __ ________________________ Water Supply: Public system 2' Community system ❑ Private ❑� Depth to Water Table ________ ft. Character of soil to a depth of 3 feet:"Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobW Hardpan ❑ Previous Application Made: Yes,❑ NoV* New Construction: Yes'X' No ❑ FH'A/VA`Yes ❑ No �C TYPE OF INSTALLATION AND SPECIFICATIONS: Septic Tank: Dista cesspool permitted if public sewer is available within 200 feet.)'• ;.,Y. . No septic tank or 'cesspool from nearest well_1� 'i�___,___Distance from—foundation U_ _ p - _ ---------.Material---- - _ - -------��____.�- �. , ; ------�'-�- No. of compartments � - Size___ ---Liquid �-'---'------'--Capacity-- - = - ---= ' Di o al Fieid: Distance from nearest well. 'k�__Distance from foundati n___ --------- Distance to neare �i -----Length of each lin „_-----.Width' of trench- _-'-- �`� f Number of lines g - ' ---- 'f? T e of filter material--_ Depth of filter ma erial_____ _i_+�`_______Total length ----- Type y rP , V` g � 4r Seepage Pit: Distance to nearest well_____ foundation___.�P_________-.Distance to,nearesf lot line.____+S-___.-_Number of pits__-_�_ ---- _____Lining material-__ ? ,,-------Size: Diameter_-33_xa.Depfft «�" - ------ -- ----------- k Cesspool: Distance from nearest well______ ____Distance from foundation----------------_.Lining materialV.................................. ❑ Size: Diameter-------------------------------------`-Depth---------------------=----------------------------"-Liquid Capacity----------------------------gals. Pr.ivy: , Distance from nearest well__ -------------- --------------------_----------. Distance from nearest building---'_.___-___________________.________._. ❑ Distance to nearest lot line---------------------------- ------ -----------11-—------------_•.___------------------ --- --- -----------•----------------------- Remodeling and/or repairi [de tribe):- ---- L� �' - - -----------------'�----•- - •--- ------- V ---------- - -- - AAL ------------------------------------------------ ---•�-•------------- --------------------+u. - .:--- -- -- _ - ---------------- ------ - - ___ I hereby ify that ave prepared this application and the+ the work will be-done.�n accordance with;5an Joaquin County Y •� ordinances, to laws, ules and a ulations of the San-Joaquin Local Health District. t pwwryrz -- ------ ---=------------ --------------------- -------------- --- ------------------------ Owner and/or Contractor) (Signed) { / ) ,� s By: .A' . (Title) (Plot plan, showing size of lot,[ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- =---- '---------------•---------------------------- DATE----- `S l-------=- ----------- REVIEWED BY `-----------`--------------------------------=------ --• DATE_-----------•-------------------------------------------- BUILDING PERMIT ISSUED---------------------------------------------.- -__ ---_ - - - -------------------------------------------- DATE------------------- ------ ------- - --------------'-- Al+eratigns,pnd/or r mm dations----------- ------------------------------'-f-------------••-------------------------------------------- ---•---------------------•-•------•••----•-----••------- // -y,z�fl lj n --- -- --- --- Tr' - ------------------ ---------- ---- ---• f---------•--------- - --- -------- -- -- ----` ---- ----- ----------------------------2=-- x -' �•---------------------------- ----- ---------- -----------------'-------- ---------- i FINAL INSPECTION BY:------------ /--/ ----------------------'---------- Date------------4p/ P� s�7j E, 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-9-2M , Revised 1-57 F.P,CO.