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- 53 O 3 0 " APPLICATION FOR SANITATION PERMIT Permit No., _ 3 CP � (Complete in Duplicate} GG Date Issued _ _ .______�f-- � Application 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./79 Q* JOB ADDRESS AND LOCATION...__ __. __�o.____d.Q,___ Cis-1�_� ___-__�_l__�______________ ._ Owner's Name --------- Phone--- -- 1 - Ox---------- - - ••f3--d l�' cad/ Address-----------------------------------------------s.__S. _t2z ---- --------------------------------- •------ _ n - Phone Name------------------------------------- ' 1 r Installation will serve: Residence D4 Apartment House ❑ Commercial ❑ Trailer Court [❑ .Motel ❑ Other [:1 Number of living units. _A___ Number of bedrooms --/---- Number of baths -1------ Lot size --------457P- __ ___________ Water Supply: Public system° Community system ❑ PrivafDepth to Water Table,._--__-_ ft. Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam ❑ Clay Loam El Clay ElAclobe� Hardpan El Previous Application Made: Yes [-] o N ;K—New Construction: Yesx No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest//w�ell 0 --Distance from foundation__�_Q___-----_.Material-- ----- No. of compartments_�.t--------------____Size_ __ _- {?____Liquid depth-_.5dy___'_---------_Capacity__��`� 3 Ir Disposal Field: Distance from nearest well_8)__Q_�'.Distance from foundation---C_q._ __:_.Distance to nearest lot line______�5.____.�,d �( Number of lines-----I_______..y._.________.___-Length of each line___'�o'5"_:�-------------Width of trench-- 9�z/ ------------------- + Type of fitter material-_-'_ �.*_r / _____Depth of filter material_____f_8!'......Total length___._.._7-5--_'_______.__-.____ Seepage Pit: Distance to nearest well :_____-___Distance from foundation___________________ Distance to nearest lot line__.__..._______ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept'h__.------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation___________________Lining material-------------------------------------- F F1 Size: Diameter------------------ -------- -- -------Depth------------------------------- - ------------------ -------------- Liquid Capacity------------------ ---------gals. Privy: Distance from nearest well-.-.--________________________-_._________._.-_Distance from nearest building__________________._________._____----- �i ❑ Distance to nearest lot line------------------------------------------------------------------------------ ------ -------------------------------------------------------- l Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- -------------------------------- -----------I- ---------------------------••--------------------•-----••-------------.--.---------------------•--------------------- ---- ---- 1 hereby certif at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ws, nd rules dreg #Lions of t e San Joaquin Local Health District. [Signed} --------------------- By: - ------------1---- ---------•---- ------------------------------------- ( y'=Contractor) 6 -- ------------------ - Gt By:--------------------------------------------------------------------------- --- ----=L----`� -------------(Title)-- ! -�-----_--------------- Plot Ian, showing size of lot, location of system in r tion to wells, builp etc., can be placed on reverse side). ( r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ '_._ ------ DATE�--------------------------------------------------- ---------------------------------------------------------------------- REVIEWED BY--------------------- --1------------------- DATE --------------------------- BUILDING •-----•---•------•-------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------ Alterationsand/or recommendations----------------------------------- --- ------------•-•----------------------•---------------••---------•---------------•--------------------------------------- ------------------------ ------------------------------------------------------------------------------------ ----.------------------------------------ ------------------------------•-------•-----•-----•------------------- ------------------------------------------------------•-------------------------------------- ----------------------------------------- ---------------------------------------------------------------------------------•--- ----------•----------------•-------.------------- ------------------------------------------------------------ ----------------------------------------------- ------------------------------------------------------- ._, - 1--------------- --------------------------------------------------'----------- ---------------------------------- FINAL INSPECTION BY:.._.____ T - f�"� Date -----4 -'._.___...�______- �--------------------------------- 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 10-52 Revised W-2100