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APPLICATION FOR SANITATION PERMIT Permit No. _- .1........ .... . �� (Comple e n Duplicate} _ Date Issued 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, JOB ADDRESS AND LOCATION. --------`----`�- ------------� ---------�------ ��'`�------------------------------------------- Owner's Name- - ----------------------------------------------- : Address...._: r --------------------------- .t�l�.• { -- ......... Contractor's Name----- --------------T- � [� _-.._.`_.. -.�__ Phone '?` _ ' ------------------------------ ---- -------- ----------- Installation will serve: Residence Apartment House ❑ Commercial❑ Trailer Court ❑l Motel ❑ Other ❑ t Number of living units:.__-_ Number of bedrooms __ _ Number of baths _�- Lot size .___-_ _. x� A----------------------- Water Supply: Public'system Community system ❑ Private ❑ Depth to Water Table !Ole-,ft l � _ Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy As ❑ Clay Loam ❑ Clay ❑ .Aclobe'4* Hardpan ❑ Previous Application Made: Yes+ j'No'0 New Construction: Yeas ❑ No�' FHA/VA: Yes ❑- No ❑ / TYPE OF INSTALLATION AND SPIIIECIFICATIONS� r (No septic tank:or`cesspool permitted if ublic sewer is avails le within 200 feet.) - a :. ' Septic Tank: rDisttance from nearest welly.- sD "Distance from foundation. t_->--._-_--_.Ma anal----.- ------- - y :_. i k ,. = p 4-1--- -Liquid depth------ > '------Capacity------?'e?. ------- ----------- Disposal ------ Dis osal Field: Distance from nearest well_ 9lL�/._Distance from f I No. of com artrnents_____ i C___________--Size___�:4_r_ - p / foundation--/- to nearest lot line---------------- Number of lines__________------------__ !'Length of each line-----�-_- ------------Width of trench::-_-_.__ - _____ Type of filter rnaterial-- r..%?}D -.Depth of filter material-------_ :` _ --.-Total length._-_ ?a�'�--_--., -- __'^---_ -_ Seepage Pit: Distance to near;;+well 7 ---- Distance from foundation_-.! �. Distance to nearest lot line! Number of pigs___-__. Lining material-- __ �-z�c.. .Size: Diameter. f_ �F___-Depth --__ „ :. r - 1 ' t Distance from foundation____ .-_-_ Lining material___-. -_-;------------------- Cesspool: � pistance from near}est well__ Size: D'iameterr.__ j {De th- ---------------------- -- ---_ __..Li Liquid Capacity- gals, ❑ r _ . -- p q I p y--------------•rt---.----•-g Privy: Distance from- nearest well1k _ -----------J------------------------------------------------Distance from nearest building----------- --------------.._ ------- ❑ Distance to,nearest lot"line `,d - - ------•- --------- -------- : . , ,. Remodeling and/or repairing (describe):_-__-_-_' __ ' _--_ , ' ------------••-----------------------,----,---------- --, ------ ------------- --------------------------------------- ----------------------------------------------------- v a-i-.1,- I . . 1 I hereby certify that-1 have prepared this application and that the work will.,6e done in.-accordance with San Joaquin County ordinances, St ws,and rules -and regulations of the San :toaqusn Local Health District. r / �� z'_ 1 = ; O�ner and dr Contractor , {Signed}---- ---------`f /, -- ( } / �'�--� �` . By:-- .................... - .' {Plot plan, showing size of lot, location of system in relafion fo wells, buildings, etc., can bei placed on reveise side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------�----------------- ------------------------ ------------ DATE-------- = - f REVIEWED BY------------------------------------------i .- = ------------------------------------------ DATE-- •-- '/ - - ------ BUILDING PERMIT ISSUED ._°.._.. " -----=--------------- ----- -------- DATE ---'-T--------- -----. Altera 'ons a d/ re ommendation ' - -,------------- -- ----- ----- r •--• ------ ------------------ . ------------------ ------ _- ----------- ------ ... -------- ----- ------------------------------------------------ = ------------------------------ ----------=- -- ----- - ---------------- ----- -- -------------------- FINAL INSPECTION BY: = t -...--------?- ------=-=_- Date_=.f�.` `'i� —�--- SAN J AQUIN LOCAL HEALTH DISTRICT M 130 South American Street 300 West Oak Street 132 Sycamore Stree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M : Revisea -1.57 F,P.GO.