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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica{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 County Ordinance No. 549. JOB ADDRESS AND LOCATION... ..../j----------: __.. _ _1. 2 .....--••-- -------------------------------- Owner's JJV697A--------------------------------------------------------------- ---- ------------------------- Phone------------------------------------ Address----------------Z.6_ -7-.------6 4_76�s JJ A A...---- -j!�A c Contractor's Name...... - R i_Sv _J:�%/C, Phone-AG _ !k Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _---IF_ Number of bedrooms .-- Number of baths ._.�'__ Lot size __7-../ '__J_�'� Water Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑- Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe PF—Hardpan ❑ W Previous Application Made: Yes ❑ No [�NawkCon struction: Yes ❑ No ❑r. TYPE OF INSTALLATION AND SPECIFICATIONS: r`.+ E (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) - V� k Septic Tank: rDistance from nearest well--;- '.-`.- Distance from foundation--------------------Material---------------------------------------.--------- ❑ � No. of compartments------ ---------------a,..-Size---------------------------- ---Liquid depth-------- ----Capacity------ ---------------- Disposal Field: Distance from nearest well __._..._£__._Distance from foundation--------------------Distance to nearest lot line___________ ❑ � �' f/Number' of lines-----------'-'- -- - - - i---Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------_Depth4of filter material----------------------Total length---------------------------------------- Seepage — � Distance 'l Seepage Pit: Distance to nearest well-./ lJ�'J� .•Distaiice from"foundation___________.-. to nearest lot [tom Number of pits________ ______ ___Lining material--vet-.4 Size: Diameter- .�__.--_.--Depth______,_ ------ Cesspool: Distance from nearest well---------------- from foundation--------------------Lining material _.._-....____.____-._-__________--__ Size: Diameter-----" ----------=-------- De th _�--____-. '__Li uid Capacity ----- aIs. ❑ 1 P� q p Y 9 Privy: Distance from nearest well.......---------------------:---------------------Distance from nearest building------------------------------------- ❑ Distance to nearest lot line--------- ----- - -- ------•------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-_ -4 ----------------------------- --------• -•--•-------•---------------•---••---•-------- ------------------•---------=----------------------------------------------------------------------------•------------------------- ----- ----------------------.------------------------------------------ F --------------------------------------------------------------------------- I hereby certify that I have prepared-this-application and that the-work will be done in' accordance with San Joaquin County ordinances, Sta ws, and rules and regulations-of the San Joaquin`Local'Health District. 9 R-J'`5� �!LJ � 6 Owner and/or Contractor) 1 (Signed)------- By: = =--------•----------------(Title)--- =: -----•--------------- ------------------- 0 -- 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 ---------.-1-/-e---------------=--------- REVIEWED BY-------------------------- ---- DATE }"P".------------------------ BUILDINGPERMIT ISSUED-------------- ----- ----- -------------- •- --------------------------------------------------- DATE--- -------------------------------------------------------- Alterations and/or recommendations:--- ------------------------- - --------------------------------------•-- --------------------------------------------------------•------•------------------- --------------------------------------- -----•-- -------------------------- ------------------- --------------------------------------------------------------•------------------------------------------------------------------------------------------------- -------------------_------------------_--------------------____----___._._.___...._-_--_..-_..y_____-----.___.-------------------------------------------------------------------------.------------------------------------- z FINALINSPECTION BY=-------- - ----------------------1=-�------ -----------sem+ Date---------- y- -�------------------•---•----- ------•--••------ 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 145446 ATWDOD 12-5a