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} APPLICATION FOR SANITATION PERMIT Permit � - �� (Complete in Duplicate) ' Sy Date Issued Applica+i ereb made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a ication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND oLOCATION---------------- --�O 17--------t--7D. -/-'T-------- ------------------------------------------•------ ----------------------------- :i, Owner's Name----------- Phone Address------------------- '--------------------------------------------•---------------------------F -------------------------------------------------------------------------------- --------------....------- Contractor's Name----1!---------------------------------------------- ---=-------------------------------------•------------------------• Phone----------------------------------- Installation will serve:'1 Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _ '__- Number of baths -------- Lot size -------1__-_'OrYe---------------------------------- Water __ ___________________________Water Supply: Public system'❑ •Community system ❑ Private Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ❑ Grave] ❑ San y Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) q Septic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material ___________.__._____.______-______________,_____- P No, of compartments---------- ---------------Size-------------------------------Liquid depth--------------------------Capacity----------------------- f f ! Disposal Field: Distance from nearest we'll.___"aQ:__ ._Distance from foundation------1U--------- Distance to nearest lot line------:C____- Number of lines_______________ Length of each line-_____:_____'�9_1-_:_.__.Width of french--_-____-2V-"e________________ r �Tixr��--, g G Type or filter material------- of filter material_._.__/3 'r ----..Total length-------------TS`/------------------ „- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 1771 _______.-_-___ _❑ Number of pits----------------------Lining material.----------------------Size; Diameter------------------.--- Depth-------_------------------------ 1+ Cesspool: Distance from nearest well-----------------Distance from fpundation-------------------Lining 'material------------______-._________________- Size: Diameter--------------------------------------De th----------------------------------------------------Liquid Capacity __gals. Privy: Distance from nearest well--------------------------..---------------------Distance from nearest building___________-_-__--__--__-_-___-______.___. ❑ Distance to nearest lot line________________________ _'__ i� 17 Remodelingand/or repairing (describe):----------------- ----------------------------------------------------------------------------------------------------------------------------------- 7. -------- ------ r --•------------------------------------------------------------------------------------- i I hereby certify,`that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws and ules andel regulations of the San Joaquin Local Health District. '`----- ' ----------------=--------------------------------------------------(Owner and/or Contractor) By:----------------------------------------------------------------------------------------------------------------------- ---- •----(Title)------------------------------------------------;---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------------= , DATE------ ----5� � ,------ r REVIEWEDBY------------- ----------------------------------- ----------------------------------------------------------- --------- DATE - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ----------------- DATE------ ------------------------------------------------------ r► oti� f-!`i +yi•a--.=+�:.= .�F.'.1"F. ' rtI -Alte tions and/or recommed - �----------- " �'•./y wl't�'/s.`�e 10 .-.r- -i--+-v-4--.�-t- _. Fo-? [AIA A410, * .-'I ` tt-q,Ar .,#, -------- - --t_ _i_ .. ------- --- iC ------- ----- ------------ ------------------------------------•----------------------------------------------------•------------------------------------------- -------------------------- ------------------------------------------------ FINAL ! ..� ' ------------------------------------- -------------- ------------------------------------------•--------------------------------- ---------------------------------------•-------- FINAL'INSPECTION BY:---------- r ------- ------------ Date = ----- --------- - ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100