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I APPLICATION FOR SANITATION PERMIT Permit No (Complete in Duplicate) j �/- - Date Issued _Ll`�' wApplication 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 �OCATIO -------- �---------------------------------------- Owner's Name----- = Phe Address r -----------------------------------�- Contractor's Name. - " " i 4` --- {-- -• --------- ----- Phone---- ----------------------------- � Installation will serve: `•Residence Apartment House ❑ Commercial railer Court ❑—Motel ❑ Other ❑ , Number of living units- - ----- Number of bedrooms e—- Number of baths -_- Lot size ` Water Supply: Publicisystem ❑ Community system ❑ Private e th to Water T ' [�p able ._._____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam '� Y ❑ y ❑r' Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No �w Construction: Yes ❑ No ❑ '�,.i+ TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank,orcesspool permitted if public sewer is available within 200 feet:)r4 Septic Tank: Distance from nearest well ------Dista fro foundation: _------.Mater al__- _. ' LYS No. of compartments____ _______________Sizo .___ -_ X't Liquid depth_-_ ------___----__-iCapacity_ T. Disposal Fi Distance from nearest well_ _.Di e` tion__,;;"a to nearest lot ine _ ! A Num er offines` -- -------- --- =4--- ength of each line--------_------------- Width of trench------ do Type of filter�materlal. ` --_ Depth of filter material_._ __ !'__ Total length__ --- _- 1 Seepage Pit: Dis ence to nearest well_.__________________-_Distance,from foundation---_-_--___-_-_-___.Distance to nearest lot line_____-____-_----_ Nk ❑ Number of pi s--------------------Lining material------------- --------Size: DiaMe,_ --------------------------------.Depth----------------------------- Cesspool: Distance from.nearest ;well______ ___Distance from foundstion______._._____-__...Lining material___-__-.___.___________- _._ ------- ❑ Siz Diameter.- -----------Depth---- ----- ----- ---Li uid Capacity .�•� --- -------- - --------- -- q ------------- -------------gals. Privy: Distance from nearest well________________---------------------------------Distance from nearest buildin ❑ _ - _. . Resnodel.in . ;and or of ati ;e to nearest lot line -------------- =;:;---------;�--- "' =-------_-----=---%-- ------ ------------------------ - -- � g I p ring [describe). ------*�r ----- � ,, - •--------- --------------------------------•- -'�'�---------------------------------- - ,. ------•--------- ------ ----------------------------------------- -------------------------------------------------------------- -- ----i-----------------•--------------- �d I hereby certify that ( have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,Iaria rules and regulations of the San Joaquin ocal Health Distr�et. !.• twro., ., (Signed)--------- -er! --�=�'• -�-�-� � �"r� - / .�.,.�,�...,... Iter - ---------------------- - -Ownerrand/or Contractor By:.------- --- t� =- ---------------------------------------------------------------------(Title)--- . . -----------= ----------------------- (Plot plan, showing size.of lot, location of system in relation to wells, buildings, etc., can be plac�d on revere side). FOR DEPARTMENT USE ONLY I.......,.,.- c ..r- APPLICATION ACCEPTED..BY-:__.rte, '' °'."" DATE-- ` - � REVIEWED BY --------- ------------- ------------ DATE = BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATES Alterations and/or recommendations:------------------ ,,. _ _— . . . ;. _ ------------ 0 y -- - ------------------------ -- ------------- 'ti"M'r ----------------------- ------------------------- - ------------ _ """�+ern+'-'------ - ---'- ---°- ` - - f i -------------------------- -----•-----'----------a------- -------------- ---------------------Z_ll ---------------------------------LfV--_ • , - - -- -------------------------------- I FINAL INSPECTION BY______________ ___ __ Date 1 -- --------V J - - ------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California F 9-2M 8-51 Revised W-2100