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L�►fir (Or APPLICATION' FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / Date Issued -------- Appiica+ion is hereby made to the Son.Joaquin Local Health District fora permit to construct and install th wo ;This application is made in compliance twit County Ordinance No. S49, e rk herein described. JOB ADDRESS AND LOCATION �. N -------------------------------------- - Owner's Q.k.i.A,l�(M ------------- "-- -"---•----- ----"•-------------------- - ------------------------ ----- Address ... 1 i &_- (C .,� 1 ----•-------- u "`ti, f"�fC._ --•-•-•-- Contractor's Name... .- -'--"-•--- = -------------- Phone. Installation will serve: Residence Apartment House [] Commercial ❑' Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I____ Number of bedrooms _�----- Number of baths ___1_-_ Lot size .-_ Water Supply: Public system ❑ Community system ❑ Private eDepth to Water Table'1_a_ ft. Character of soil to a--depfh•of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe ►a' Hardpan ❑ F Previous Application Made: Yes p No ❑" New Construction: Yes R1 No ❑ =-; E TYPE.,OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Tank., Distance from nearest well-_;______________Distance from foundation__ _-..____.Material No. of compartments------------ ------------Size--------------------------------Liquid depth--------------- ---------Capacity--- Disposal F" Id: Distance from nearest well--------------- Distance from foundation-------------------.Distance to nearest lot line_____.______.___ �� Number of lines-------------------- -------------Length of each line-----------------------""-----Width of trench--------------------------"""-- . --- ype of filter material-----------,- ---"""----Depth of filter material_....-`--------- -----Total length-------•--------•---__---- -�j-----. Seepage Pit: Distance to nearest well---7-�__--:rDistance fro foundatiorO-"W—k-----.Distance to nearest lot line_-`S._.._ Number of pits___..:1_--------______Lining material--� " Size: Diameter__..)- ------------Depth _--_ _ _� Cesspool: Distance from nearest well----------_------Distance from foundation..._-__.._...__..__.Lining material__.___________..____.______.______... ❑ Size: Diameter -v #---------:------------------De til Liquid p ---------- -------•-------- --------------- -----Li ui Capacity ----------•----- --------gals. Privy: Distance from nearest well.................. ....._._--__....._ ---..--Distance. from nearest building ❑ Distance to nearest lot line.....___._____-_________...___ -- Remodeling and/or repairing (describe) - "�.e- c� ..:- --------- ------"--- - ------------------•--,----- -- ------------- -----••- ----------------------------------•-- ----••----------•--•-------------------•----•----•-------•-------------------•-----••--------- -------------------------••------•-----------------••---------•- - --------------------------------------- -----"--•"--------•---------------------------•-- ------------------------"------------._._--------•---------•----•------"----------•----•----------•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Si ned � � I 9 )----��- - --- ------ -�---�--.'p-,-------------------------------------- --------------------------------------------- ------- (Owner and/or Contractor] BY=---•---•---- ' �ci�.NCJ�et� (Title)) (Plot plan, showing.size lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ----- ------------------------------------------------------------------------- DATE----J-' 3" " IWED BY-------------------------------- ------------ ----------------------- ---------- DATE_ BUILDING PERMIT ISSUED----- -- ----------------•----------- Z�w DATE. = Alterations and/or recommendationsAj ----- t •• v `` ► -------- ------------ - - ---- - -- ------- - t olid ib _.M = ^^�^-� �. --- -------------- A-1 e ---� - LJr�.... y cls CFINAL INSPECTION BY: ------------------ - ------------------ --. Date--• .'°""" eg_ -� ^-- -------- 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 145446 ATWUDII