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�-� APPLICATION FOR SANITATION PERMIT Permit No. _____- (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and alI f e work herein described. Thisap lication-is made.in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI N__ 0 -1 ------�-�-=�/�/------•--•---_-- Owner's Name .... --- - ---•------•- ----^--------------- " Phone. � . II Address.................... .7._4 ! - _--------- - s r�••- Contractor's Name_________________________ Phon ---------------------------------- Installation __ f-_ � r --------- ------------------------------------------------ - Installation will serve: Residence 2"*-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- __ Number of bedrooms...?___ Number of baths ---!-- Lot size __l4 4_ _, __. ,, - '-----_________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table "ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ No PR-'New Construction: Yes ❑ No E!}" .� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well._.-$~P__F___Distance from fo -ndation____- ! _-Materiale' &h ____ --____-_--. ❑� No. of compartments----- -------------Sixe-_",K -4-- -------Liquid deph----.. -----------Capacity--- -------- Disposal Field: Distance from nearest well.. ...Distance from foundation---r2_4t........Distance to nearest lot [ �- Number of lines---------/-----------------------Length of each line-------7-5-'._.--------Width of trench----- .5!��------------------ Type of filter material=_Si_�D� .._Depth of filter material------��... ----.Total length------,'_�_ -•---- V� Seepage Pit: Distance to nearest .....- _Distance from f undation___-?• --___.Distance to nearest lot 0� Number of pits------/ _________Lining material-_k _.__.Size: Diameter__., 2....._-.----Depth....... ------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-____________________________________ � ❑ Size: Diameter.-------- --- ------Depth---- ----------------------------------------------Liquid Capacity----------------------------gals- Privy: Distance from nearest well-------------------------------------------------Distance 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 accordance with San Joaquin County ordinances, State avrs, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------(61 1 A , le Le L4 :_ wner and/or Contractor) By:----------------- r �--------- w� /r --(Ti+le) •-- 1 (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------------- ----- --------------------------------------------- DATE------- ---------- --------------------------------- REVIEWED BY-------------------------------"---- ----- ------- - --- = -------------- DATE------- --- BUILDINGPERMIT ISSUED---------------------------------------- -�- ;----------•----------------------------------------- DATE-------------- ---- Alterations and/or recommendations:___________________________ -------------------------- ------ --'--a------ ---------------------------------------------------------------•---------- -------- t------------....-------- ----------------------------------------------------------- ----------- ------ -------------- ----------------------------------------------------------------------------•----•--- ----- ------------------------------------------- --- ---- - •- - "----------- ---- •-----•------------------------------`------------- -------------- ---••-------------- 31 -- ----------- -. Date.---._: . FINAL INSPECTION BY:. - - - (( --------------------- ---- -------------------------- 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 E5_9 115446 A7Wp4D