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l ' APPLICATION 'FOR SANITATION PERMIT Permit No. ...._Z (Complete in Duplicated / Date Issued Z07 • Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install r rein ribed. I This application is made in com pant with unty Ordinance No. 549. JOB ADDRESS AND LOCATI .7� -. � ' - - ._ ,___. ....-. Lh. r� Owner's Name.` . - ...-'------'---'--- -------- Phone -- ----...- Address........ .................-'- ' -- `-.... - ......-' - ................--1 ......_...... ......--_...------ Contractor's Name.....--'-d +�- -'--•----1� '.`•".•_-'.--.-_..�.1r.�t�4e. .l.. .L/Lr.U"t' :+---.... Phone..�jC. c -�(o Installation will serve: Residence ['"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.l.. Number of bedrooms-4?-. Number of baths _./.. Lot size __,& ..._- ............... i Water Supply: Public system ❑ Community system ❑ Private "Depth to Water Tab] ft. ft. Character of soil to a depth of 3 feet: Sand E3 Gravel E3 ' Sandy Loam[Clay Loam ❑ Clay ❑ Adobe E] Hardpan F]Previous Application Made: Yes 0 No Er New Construction: Yes ®"'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted.if public sewer is available within 200 feat.j Septic Tank: Distance from nearest well . ----_..Distance from foundation----1�........Material...Ga_.�'_...kv _.. ... .......... No. of compartments-. --..._Size. -- . q .....<....) ?' /4 .Liquid� �j �• P �" - . " depth..... Caaci f- P ty..rr ---`- Disposal Field: Distance from nearest well.*?-/-0_....Distance from foundat II-114V to nearest lot line../ ...... A" Number of lines....._..... Length of each lin... O _ _ .r... .. ....Width of french---- ----------- Type Type of filter meteriaL�Z.. De +h of filter material.-. �� To+al length_...... - f i 1 Seepage Pit: Distance to nearest well......................Distance from foundation........._......_._.Distance to nearest lot line.-------......... ❑ Number of pits.:..............-..Lining material__._..................Size: Diameter.......................Dept h._........._............. ._.. Cesspool: Distance from nearest well............__Distance from foundation------.............Lining material_,---------................ ......._. IiV ❑ Size: Diameter..---"--=-------..._.---..Depth----.....---------------------------------------..Liquid Capacity.-----"--...._..........gals . •Privy; Distance from nearest well..........._..._..-. ..... ...........Distance from nearest building --. - ❑ Distance to nearest lot line................ ...:..._....__....._........ ..._.._ Remodeling and/or repairing )desclibe):...._.. ..>.> � --- --- .., --- ----------------- --.-..._--- ------------------.'--••.•.--• ...................----.......... . . . ... 1 ---'--...._........ `-......--.........----•--.........------------......._.._.......--- ........ ----'-_......................................... 1 I hereby certify tha+ I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, $tate laws, and rules end regulations of the San Joaquin Local Health DisMct. (Si Heal........ 9 ) ....... . . . '--- - " --- - -. .... .. -2'C-.... -_-_----- r Contractor) j t BY:._......-------'._' ............ ..... - _--------- . ....(rtie�.... (Plot plan, showing size of lot, tion of system in relation to walk, buildings, etc., can be placed on reverse sidiR. r FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED 8 . ......... -------..._........:.....--- -- ------------------------------------- ._......_ - --------- ---------------.----- DATES .------------- ------------- REVIEWEDBY------- --------..--- ... ...------I......................-.................................... ----.--- DATE.,,,.---.... BUILDING PERMIT ISSUED..._.-._ -------......................................_................. .. DATE..-�...............:....... ._.. ---- Alterations and/or recommendations:.............................._..__....._.....---.....'.-......--'--v--_.-.....---.....--..s' s. i .................................................. _._--..................................---------......`......._.------......... --......__.._........_...-'---..._---.'--............'.......--.._......................._.....-..................------------------- ..:'-...-...................------'---...__---------'.,............-......................._................................_.............--.:_........................................... ...._.................._.. -------- -------------...........I........_................ ..........._......................------...-`-_........_...................1....:.-/-.._......_...................................... FINAL INSPECTION BY:...--- .16Z...................................... Date.. ........_......- -----..._.... - • i SAN JOAQUIN LOCAL HEALTH DISTRICT- 130 South American Shat 300 Wast Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California tosee ,.z.,u Arwvvo ,za,