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I APPLICATION FOR SANITATION PERMIT Permit No. .--_ i (Complete in Duplica e) /I� p Date Issued ------- x - Applica{ion is hereby made to the San Joaquin Local Health District for a.p'ermit to construct and install the work herein describ I�d. This application is made in compliance with Couqy Ordinance No. 549. ! I JOB ADDRESS AND LOC TION__.__- ------ -- - ,. �I --- ------------- ------- -- ------------------------------------ ----------•------- - Owner's Name- /---------•---------•------ --- Phone. ------------- ----- -------------- Address - R kf—i LcJ�----rt -------•---•-------- Contractor's Name.----- .....---•• - ----------------- ------------ Phone_-------------_--------------- Installation ------•------•----- 'Installation will serve: , Residence, Apartment House ❑ Commercial ❑' Trailer Court ❑ Motel ❑ Other it Number of living units: __j... Number of bedrooms 4—.- Number of, aths -_.1___ Lot size ___G-> - 6-( ---------------------!i - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --- Character _Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay i P ❑ ❑ Y ❑ Y ❑ y ❑ Adobe�Hardpan ❑ Previous Application Made: Yes ❑l NoJ New Construction: YesKNo El TYPE OF INSTALLATION AND SPECIFICATIONS: !` P n _ �.�istance from foundation--- }�_-.-_-. !I No septic tank or cesspool ermined if blit sewer is available within 200 feet. Septic Tank: l Distance from nearest well Size-__ - __ _--_)(.-'F---Liquid depth---___- -4- _________Ca__ Q Material--___ rE . No. of compartments.__.„'--_-_ `�� - Disposal Field: Distance from nearest. well-�A,kcf—Distance from foundatio _��--f.___--.Distance to nearest lot line-_. Number of lines---------- -------- ------- ength of each line----_-. ---C'�__.----------.Width of french----- --- ----- -----�_-- Type of filter material__-.. Ci filter material-.- _ _ '....... Total length------al- _ -----------------Il_ Seepage Pit: Distance to nearest well_____ _______________Distance from foundation-----------.........Distance to nearest lot line-------------,I-_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------.Depth-----------------------•------- I`-- �} s r Cesspool: Distance from nearest well-----------------Distance from foundation.--__.____----_. Lining , materia l-_.___-.__.__.._.-_ ?El Size: Diameter-_ _ _____________ _ Deptht Liquid Capacity-------------------------------- --------•-•-----__-_-----------_-_-_---�1� -- tgals. Privy: Distance from nearest . yell__________________ _______________._-.-__r-�pistance from nearest building._--.___--.______-_--••-------------- 'Di sfance _____'Distance to nearest lot line-----------------------------------------' , — Remodeling and/or repairing (describe)----------------------- -----------------•----------_- I --------- -------------- ?---- r - •-------•---------•....-------••---••-----------------•-- -------------------------------- M �. ,. ... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, iF I . (Signed)_ •------ -- -� -- � - -- -1'�- --��'--"------ •- --- ----------------•--------------(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 �I r APPLICATION ACCEPTED BY------- --------- - - ----------------------- ----------•----------------------------- DATE...... '� REVIEWED BY------------------------------------- ------ DATE----------- 1k 1 BUILDING PERMIT ISSUED------------ I --- -- -------- - ---------- --------- ----- DATE------------------ IM- .a Alterations and/or recommendations:`-- ---------•-------------•-------------- -----------•----------------------• _€. ----•------------------------------------------------ --------- -------------- ------------- --------------- - --------•----------------------------------------------- - ----------------------•------------------------------- ------------ FINAL INSPECTION BY:-----Y_-_--� A_ r --------------- Date----- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerio'an Street 300 West Oak Street 132.Sycamore Street 814 North "C" Street Stockton, California Lodi, California ` Manteca, California Tracy, California ES-9-2M 145446 ATWOOO 12.54