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� Permit No. _.0---�.�-�--- C �\ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate} pate Issued --- 1 " 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. ec JOB ADDRESS AND LOCATION--------- _Ict_/4.�0+-- �lt!/xjl,SL' �2--- -------------------- p ' /9.t2a�61i? Phone�G.-r_lo.�a-y Owner's Name-----•-----------------------------------Zlhlb -------- - Address - - ----------------------------------------- Phone--- ___________________ /1 /_. r---�- 1"7► 2�'� _s -._ hIJS�____ ____IXC.__-____- Confiractor's Name__.______. !�-�,! Installation will serve: Residence X Apartment House ❑ Commercial [I Trailer Court ❑ Motel ❑ Other df❑ rooms .3--_ Number of baths Lot size -------------------------- Number of living units: _ _-___ Number of bedWater Supply: Public system JK Community system '❑ Private E] Depth to Water Table ______-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2' Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No f$ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic lank: Distance from nearest well_________________Distance from foundation--------------------Material-------_______________________------------------ Size ----------- -------Capacity----------------------- y,. 7 No. of compartments----------------- Liquid depth----_------____-- - pawl Field: Distance from nearest well________________Distance from foundation_____________--___Distance to nearest lot line________jga ,�"`�.j Number of lines-------------------------=---------Length of each line------------------------------Width of french-------------------------- Type of filter material--------- ---------------Depth of filter material-----------------------Total length---------------------------------Seepage Pit: Distance to nearest well--I___b_? �____-_Distant fro foundation-_l ---.Distanc� to nearest lot line_-LamDe th----.2-.--- Number of pits____-__-/_____-_____Lining material_ _.Size: Diameter_____ p Cesspool: Distance from nearest well-------_________Distance from foundation__________________.Lining materia l____________________-------- ❑ Size: Diameter Depth ------Liquid Capacity--------------------- Distance from nearest well___________-------------------------------------Distance from nearest building_______-.______.-_-----..-------, Privy:❑ Distance to nearest lot lineQ---------------------- ----------•---- ------------------------ --•--------------------------Remodeling and/or repairing (describe):-------_=o.t--�4�_ ------ --------------•----------------- ------------ --------------------- ----------------------------------------- ---------------------•-------------------- ----------------------------I----------------- ---------------------------------------------------------------------------------------------------------------------------- I hereby certif that ! prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and ule and regulations a San Joaquin Local Health District. (Signed)--- > ------ -R-91S __ '`4-- - Xt1 ;[ Contractor) a 1 By:----------------------- J�+ -----------------------------------= --------(Title} aS rk1 ----------- By: -------; (Plot plan, showing size o o#, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY__ _ _-.- DATE-� - -------------------------------------------- -------------------------------------------------------------------- REVIEWED BY---------------------- ---------- -T--------------------------------------------------------------------------------- DATE--------------- BUILDING PERMIT ISSUED-------------------------------- -------------------- -- DATEs r Alterations and/or reco rn. menciatians____________________ ---- ---------------------------------------------- # ----- - ---------------------------------- -------------------------------------- J� Date--- f ! - Y - r ------------=---------------- FINAL INSPECTION BY:---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. ES-9-2M 8-51 Revised W-21DO