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Q/ APPLICATION FOR SANITATION PERMIT PerNit , _..Il..-3_�.6.... (Complete in Duplicate) � Date Issued _ . ------ Applica+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_:. ------------- ----------------- ------------------------- ---------------------- ---------------------- 2- Phone lcx Owner's Name------ l � ------- -- ---- -----•-------- -- -- --------------------------- ---- - ri -�-� ------------------•----••--=-----------------••----------------•-----------•--- Address-_-_1 6-='�� _22 ......�-I/6---------- Ph Contractor's Name ---------- one.- - ---- Installation will serve: Residence Apartment House [ICommercial Q Trailer Court [I Motel ❑ Other El Number of living units: Number of bedrooms -------- Number of baths . ._ Lot size ___---.-;7 — ----------•------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay,Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No.E�j, New Construction: Yes �K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,. : (No septic tank or cesspool permitted if public sewer is available within 240 feet.] Septic Te ante from nearest well ..............Distance from foundation-----------------_.Material___......______..._.___._..___.__--,---.-_----• d�` f compartments--------------------------Size----•----------------------- Liquid depth-- -------------------- Capacity...-------------------- Disp❑osal Field: Di nce from nearest well-----------------Distance from foundation......_.-_---_-.---Distance to nearest lot line_............... ❑ uin of lines---------------- -----------------Length of each line-------------- -=------ ....Width of trench------ Typ of filter material-------------------------Depth of filter maternal-----------------------Total length-.----------.------.-----------.---------- r / Seepage Pit: _ Distance to nearest well---_1 +s#ante from fou d0ion___..- --.--.Distancertp nearest lot line.. ._.__ Number of its.- --- Lining material.. �----- -.- - Diameter- .----Depth__. ----------------- N ---- - i p. a i . Cesspool: Distance from. nearest well-----------------Distance from foundation---_.---------� Lining material-_._______--------.-..._....___._.. ❑ Size: Diameter--------------- ----------------------Depth-------------- -------------- -------------- ------Liquid Capacity--------- gals. I Distance fromnea ' rest building Privy: Distance from nearest well------ ------ ----------------------- --------- g----------------------------------------- ❑ Distance to nearest lot line-------------------------------------------------- = -----• --- Remodeling and/or repairing (describe) -------------------------------------------------------------------------------------------------------------------------------------- ------------- ---------••-----•-------------------------------------------- ---------------------------------- ------- ----------•------------------•---------------------------------------------------•---•----------------------- I heieby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulations of the San Joaquin Local Health District. - ------------------- ----- Owner and/or Contractor) (Signed---- a ----- - -- ----------- - - I l {Tit e)---•--C- By-- ----• �11�—- --: G (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 APPLICATIONACCEPTED BY--- ----------------- ------ ------------ ----------------------------------------- 1 DATE - --- ------ ------ ------------------------- REVIEWED BY--------------------------------------------- ----- DATE_ -- BUILDING PERMIT ISSUED-------- ------------------—--- -- ---------------------------------------------- ------ DATE_--------\.. -------------�--------- Alterations and/or recommendations: ---------------------------------- - ---- •---------- ,^------------ --=---------- -- dD ---------------------- - - 1 ------------ -------- - ----------------------------- -�, v 0 --------------------------------- -------------- -------- --- ---- - ---- - ---------------- ---------- ------- --------------------------------------------- ------- Date---------- - ------ - ------------ ---- -------------- -------- f _ FINAL INSPECTION BY...____... / m -------------------------- 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 145446/TWOOo -rw