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APPLICATION FOR SANITATION PERMIT Permit No. __•. , {Complete in Duplicate} � Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thework This application is made in compfiance with County Ordinance No. 549, rk harem described. JOB ADDRESS AND. OCATION_____"_"-" - '------ -- --- Owner's Name -- - h"4 -v►~��---- ------ Phone ---------- -- - - ------- - -- ------------- - - - Address--------- - ---------- ----I-------------u� �u R --�------ a�-------------------------------------- Contractor's Name----------------------- __--_ L A, , � --- -------------------------- ----II ---------------- ------ u------------•----------•--- Phone Installation will serve: Residence Apartment House ❑ Commercial Trailer Court it ❑ ❑ Motel ❑ Other ❑U" Number of living units: "- _ Number of bedrooms -_ _ Number of baths Lot size __ ;II. �---x------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sand fl Loam Clay Loam Clay YI ❑ , y ❑ y ❑ Adobe' Hardpan ❑ Previous Application Made: Yes [j . No ZK,,- New Construction: Yes No El FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: r € (No septic tank or cesspool permitted if public r is available within 200 feet.) f Sep Tank: Distance from;nearest well 2 istance from foundation__- "-Q-.------.Material_.. "". _---------- No. "_" ' -. of compartments___-_�---------------Size. " , 'Liquid depth----------- Capacity__. Ic- Disposal Field: Distance from nearest well, istance-from foundation�_L�o__ -Distance to nearest lot line--- -____-'____ ' Number of lines----_--:rr Len th 'of each line- i` f 9 F .W�dth of trench-----,2. -. Type of filter material___._ . Depth of filter material---- �- ��------ ��-- ---------Total length---- --- Seepage Pit: Distance to neares well"""` j-r_ istance f oir� f u a ion"""__��0" {{ F. - _ .D"s)epc to nearest lot 'ney,_jb-_-. Number of pits..! -----------------Lining material- : Diameter"_ �1C Depth � --------------- N:. Cesspool: Distance from nearest well-----------------Distance fro foundation--------------------Lining material-------------------------------------- El -____------------_____----_- ❑ Size: Diameter ----------- Depth )U -- -----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------- "___-.Distance from nearest building g--------------------------------------- ❑ Distance to nearest lot line - `-I ---- --------------------------------- -- Remodeling and/or repairing (descrilbe):--------------------"-------------------------- ------------------------------------- _ --_ ------------ r -------------------------------------------------- if --- - ------------------------------ ----------------------------------•------ ----------------------------- -------------------------------------------------------------------------------------------------------------•------- ------------------------------------------------------•----------------- ---------------------------- 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. } _"---"�": (Signed)-- � '� — --------------------------------------IEE---------------------------------------------------------(Owner and/or Contractor) '\\ By:------ t -----------------------------------------------� -------------- Title (Plot plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). e t FOR DEPARTMENT,�USE ONLY APPLICATION ACCEPTED $Y----------j__--------- __ ----------------------------------------- DATE-..__: -- - -- - -------- - REVIEWED BY----------------------------- ------'j---- ---- ------ ---- --- - ----------------------- DATE BUILDING PERMIT ISSUED--------------- ---- --"- - -- --- _ II' ----------------- ----------------------------- DATE " Alterations and/or recommendations:"____.---_" ---------- Sia. vw W------Le- ` � i� ' ' "' -i4l1 Qr —;-� s�5'------------------------ ------------------- ------------- ---�-�----------- r ��-�� .., re .� 9-----� = --------------------- --- FINAL INSPECTION BY----------------- -------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 5 Stockton, California Lodi, California i Manteca, California Tracy, California ES-9-2M Revised 1.57 F-P.Co-