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APPLICATION FOR SANITATION PERMIT ` Permit No. .__: . ..__ ,) [Complete'in'Duplicate) f 1�4 - Date Issued - 7-s2 1 plication 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. t JOB ADDRESS AND LOCATION-_____-_____JI ---- ----------------------------- I Owner's Name--------+------ r- -- -------- Phone_0/7--0 O r� / ---- - --------------------- --- -•---- ; Address---------_171 �, ,.� •----------------------------------------------------------------- -•----------------------••-•------- 1 Contractor's Name___-_ _ ----------- ��"r't� --------------------•---------- ---------------- Phone - -e14 .mss Installation will serve: Residencep ----------- ' A artment Nouse ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: ---- Number of bedrooms Number of baths s .�__- Lot size ------ Water SuPPY� uI Public system y Community system ❑ Private ❑ Depth to Water Table y� ft. Character of soil to a depth of 3 feet; Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: YesE:1 No V New Construction:' Yes ❑ No Ke TYPE OF INSTALLATION AND SPECIFICATIONS ( No septic tank or cesspool permitted if public sewer is available within 200 feet.) I jo Septic Tank: Distance`from n crest well-------!'lm------Distance from foundation------ ------- Materi I__� 4 No. of compartments--------------------------$ize_S`rQlfS-___Liquid depth-------4/-- .'7–.----..Capacity-••---� Disposal Field: Distance from- nearest well__-.._:�o-------Distance from foundatio _ /.0-l-_.Di€stance to nearest lot line ___�l-.-- e Number of lines_--_--------/------------------Length of each line------��_.___.._------.Width of trench------ T e of filter material.__S•_rr_ i� -- --------------- Type ,? __Depth of filter material______-/ Total length ------------------------ Seepage Pit: Distance to nearest well----------- -_-Distance from fou dation___,/-_ ._..Distance to nearest lot line______.__-__..__ jx Number of pas-----J-----------Lining MaterialS c' '� -Size: Diameter A....----- Depth--------: -------------- Cesspool: Distance from nearest well-----------------Distance from foundation ______ Lining material------------------------------------ ❑ Size: Diameter ------------------------- Depth ----- -- ------Liquid Capacity- --------------------- ----gals. Privy: Distance from nearest well-------------------------------------------------Dis#ance from nearest building Distance to nearest lot line - - ------------------------------ _ _ _ ------------------------------------ ------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------- < ------------ ----•--------------------------------- -------------------------------------------- --------•- -----------------•--------•---•-------------------------------------•-----•-----------•--------------------------•-------------------------------------•--- I hereby certify that'I have prepared this application and That the work will be done in acordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ ------------ ' I -------------------------------- ---- ----.- -- -_( w - ner and/or Contractor) ey:... - (rtle)- - --- - --- ----------- ---------- - {Plot plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --------------------------------------------------- Jrf,S�, DATE REVIEWED BY ------------------- ------- --- - -- -- -- ------ DATE---•---------- ---�--�•T----�--------- ------------------------- ------------------------------------- -- BUILDING PERMIT ISSUED___________________I-___-- ------ -------------------------- DATE --------- Aterations and/or recommendations:.--r ---------------------------------- ------------------------- ---------------- --------------- - ----- ----------------------------- _ � -- -- - - -- ------------------------ - FINAL INSPECTION BY------------------------ � � � ------- Date-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street 132Sycamore Street 1 814 North "C" Street Stockton, California i Lodi, California Manfeca, California Tracy, California ES-9--2M 10.52 Revised W-2100