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Permit No `(1--2Zz APKICATION FOR SANITATION PERMIT iQ (Complete in Duplicate) 3 y Date Issued ______________l___�d s Application 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. I CC v�'ft Q tJQ_- rN JOB ADDRESS ANQ LOCATIO,ell ` ` v ��-Gv--_C .,.. r Phone------------------------------------ Owner's Name --- ---- CJ------------------ ----------------------------------------- -1-- ------------ 5_0-7-,5 ------------ --- - --------------------------- Phone-.--•------------------- ---------- -Contractor's --------- -Contractors Name-------------------------- ----------------------------------------------------------------------------------- Y Installation will serve: Residence �A artment House ❑ Commercial ❑ Trailer Go rt Motel❑ Other ❑ Number of living units: -------- Number of bedrooms -- Number of baths -)----- Lot size -12 = Water Supply: Public system ❑ Community system ❑ Private�%'Depth to Water Table '7Q_ f+. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 12� Hardpan ❑ Previous Application Made: Yes 54—No ❑ New Construction: Yes ❑ No �J, FHA/VA: Yes ❑ NON r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 240 feet.) Se-tic Ta k: Distance from nearest well_____.__._-__-_Distance from foundation-------------------_Mate ria ,F No. of compartments----- -------------------Size--------------------------------Liquid depth Capacity ! DisposalField: Distance from nearest well-----------------Distance from foundation----P__--____-___-.Distance to nearest lot line___-__________.. l `1f Number of lines----I---------- ------ Length of each 4ine__/*_f10------------------Width of trench---2Yr-------------------- Ct�%vr` Type of filter material____ Depth of filter material_J -__-_.___-__Total length_____l� _____ _._______ _____`�_ -0______.D,is+ante to nearest lot Iline_____6_-.___.. Seepage Pi+: Distance to nearest well_lQC�_•_______--Distance f fou dation__ Depth-___..{�-_._-_________________OJI ®/ Number of pits--- ---------r------Lining ma+eri Size: Diameter ._ i Cesspool: Distance from nearest well_________________Dis ante r.m ou dation---_______-._____.Lining material____------________---________.__----- -Liquid Capacity -----------gals. Size: Diameter--------------------------------------Deph--------------------- ------- ---------- J Privy: Distance from nearest well------------------------------------------------ Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line-------- ---------- -------- ---------- --------- -l------------�--------------------------------------- --- ----------• -------------------- - ------------ yi} ------------��d, �c ----------------------------- Remodeling and'/or repairing (describe)!----------------------------------------- ---------� - --------------------------- ----------------•-------------•------------•-:---------------------------------- - ------------------------------------------------------------------------------------ ----------------- r -----------1-----------------/-------------------------------------------------------------------------------------------------------- I i hereby certify that I have prepared this application an that the work will be done in accordance with San Joaquin County Y I ordinances, State laws, and rules and regulations of the Sa Joaquin Local Health District. fontract or] ---------------------------------------------(Owner and/or C (Signed) - ----- •-- -- --------jitle)-------------------------- By:--•---------'--------•---------------------------------------------------------------------------------------- i (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 REVIEWED BY------------------------------ -- ---------- ---- DATE -- - _ ----/W BUILDING PERMIT ISSUED------------------------- -------- ------ --r------- --------------- - ------ DATE----------- ---------------------------------------- - Alterations and/or recommendations----------------- - ----------- ----- - ---- - --------------------------------•------------------------------------------------------ --------- _ ----- ----- ------------- _.._- --------- - ----•---- --------------- ---` �� ^e�--�" -------w------------ - - ---------------------------------------------- -- --------- - f -illw�_ FINAL INSPECTION BY------------------ Date--------- - -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 5 camore Street 814 Nor+h "C' Street 130 South American Street 30D West Oak Street y Trac California Stockton, California Lodi, California Manteca, California Y. ES-9-2M Revises 1.57 f-P.CO.