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.� APPLICATION FOR SANITATION PERMIT Permit No. _151f (Complete in Duplicate) ``� Date Issued ___.___T__}x_____. Applical-ion 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. JOB ADDRESS AND LOCATION------- --1-1J-4 4-----------e-------A --------------------------------------------------------------------------------- ---- Owner's Name--------- ;.`a ----•-e ---- - -------------------------------------------------------------------------XPhone Address------------- / g ?- --------,ID•----rA,---------------------------------------------------------------------------•-• ------------ ----------------------- Contractor's Name--- - =" Phone_ fJ.-GF•�� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -._ Number of baths _1---- Lot size ------ _________-_ Water Supply: Public system , Community system ❑ Private'[] Depth to Water Table .�,0_ ft: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M. Hardpan ❑ , Previous Application Made: Yes ❑ No 0- New Construction: Yes B-.No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tanVor cesspool permitted if public sewer is available within 200 feet.] Septic Tank: Distance from nearest well ;W_t,--A_Disfance from foundation----&f-------Material_____e_Ca----4 <_______. ® No. of compartments-----_t�,-----------__Size...... ____ Liquid depth____-&__:p----------Capacity__.��' ______ r Disposal Field: Distance from nearest well__07-LAIstance from foundation----,l_ __ __.__.Distance to nearest lot line__.2D1'_..... Number of lines----------- Length of each line------- 0-----__-------Width of french------ /I Type of filter material___._ ____ Depth of filter material___._)" _.__"-----Total length------ - ------------------------------- Seepage ----- ---- --------------- Seepage Pit: Distance to nearest well----/Vityye_Distance from foundation---1/_�__T------.Dista ce(to nearest lot r [9 7 Number of pits.--.---1____------._Lining material----�-�1� {Diameter-----� ---�-___..Depth_..-.�'7�__--------- • Cesspool: Distance from nearest well------------------Distance from foundation------------------_- Lining material-_---__________.___._________________ ❑ Size: Diameter---- '-----------------------------Depth------------------:---------------------------------Liquid Capacity----------------------------gals. �t Privy.-: Distance from nearest well_____:_-----------------------------------------Distance from nearest building--------------------------------- Distance ----------------- ________-_-Distance to nearest lot.line----I--------==------------------------------ ----------------------- ----------------------------------------------------------- f Remodeling and/or repairing (describe) = --------------------------=-- -•-------•--•----------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ ----------•---------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and,that the work will be done in accordance with San Joaquin County ordinances, Sta s, and rules and regulations Gof the San Joaquin Local Health District. Si neo ��/_ _ �---- ____________________________ ____Owner and/or Contractor BY� �� -. -- (Title)---- ------"n----------------------------------- By: plan, showing size of'lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- ----------- ---------------------------------------------------------- ----------- DATE-�r__ ----------_------ --------------------------------- --------------------------------- REVIEWED BY----------- --- -----•---- -------------- -------------=------------------------------ ------------ DATE--- Z-- - ED ------------------------------------------------ BUILDING PERMIT ISSU ------_---- . ------ DATE------4h ------ Alterations and/or recommendations:-----------------------------------------------------------.................................... ---------------------- -------•------------------------------- --------------------------------•----•---------------- _---------- -------------------------------------------------------------------•------------------------------------------------•----------------------------------- -------------------------------------'--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- FINAL INSPECTION BY:-----------"- -f/__......`.-"-------------------- Date"------ -- --- ---- 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 Revised W-2100