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1 APPLICATION FOR SANITATION PERMIT Permit No. _` __c -- ` (Complete in Duplicate) Date Issued Application is hereb�}e ado 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. C^'`�r7 � jI �1 -r----- - ---•--------------------------------------- ----- JOB ADDRESS AND LOCATION_________0�--_,+VJ-to -- -f--t `�`�"�"-0- _/ Owners Name-----------•-------•---------•-••--------------------^--- - ------------------------------------------------- Phone------------- ------•-------------- ---------- --------------------•-------------------------------- ---------------•----------------------------•----- Address------------------------------------------------- Contractor's Name---------------------------- ...... -- ,R -� Phone -, ��! Installation will serve: Residence [jg, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f.-__ Number of bedrooms -- Number of baths __t___ Lot size ----OT_t_+__A----- -- T"-----------•------ Water Supply: Public system ;K Community system ❑ Private ❑ Depth to Water Table a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: Yes ❑ No W New Construction.- Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from foundation__._ Material------------------------- - ---- Septic Tank: Distance from nearest well: ____ .. -- 4 a � -- . . � �f Liquid de th__. __Z__--.______._Ca acit ,fQ42_ .4, No. of compartments_ l Size __ .------- D _-_- . _ q p. P Y 111 r ' Disposal Field: Distance from nearest well_h�Q-- Distance from foundation__ _______________Distance to nearest lot line______ ,jj��_.�__�. Length of each line__/D______________________Width of trench-2N_d� +.__jL°'`-`-'dLl Number of lines___.__ _______- __ _ � , A n Type of filter material--I_ i -Depth of filter material-------/___f'�____Total length_ __J10__1.----.L_7.-`' ____. Seepage Pit: Distance to nearest w .___ ---------Distance fr m foundation----�S_......Distance to nearest lot line__'!--- Number of pits___-/----------------Lining material.------:Size: Diameter---3.3!`__-___.Depth_____ ;IL-`r-----__._____..___ I Cesspool: Distance from nearest well-------_---------Distance from foundation-------.-.----------Lining material-----------.--_.____.________.__.__- r1 ❑ Size: Diameter--------------------------------------Depth---------------------------------- ----------------Liquid Capacity---------•-----------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------ ---- ❑ Distance to nearest lot line------------------- ------------------------------------------- --------------------------- --------------------------------------------- y r_ - .-.` .�----------------------- Remodelingand/or re ringclescribe :__-`�-- GS/ - --- ------- ¢/t'"�sk ----- - _ (. ----------------------------------------- -- ----- ----------•--------------------------------------- --------- ----------•-------------- ------------------------------------------------------------------ -------- ---- -- = -- ---------------------------------------------------------------------------- ------------------------ I hereby certif,that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State la s, a rules and re ations of the San Joaquin Local Health District. 4 (Signed)_ ------- ----- -Li �r Contractor) ----------------------------------------- Y•- - ----------------------(Title)---- �- -----------------------B ' -- (Plot plan, showing size of lot, location of system in relat' n o wells, bu dings, etc., can be pla ed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ---- -------- ------------ ------------ �.{ DATE---------- -- �J REVIEWED BY-------------------------------------------------------------------- - ---- -----------------------•------------ - W 4F/------- ------------------ BUILDINGPERMIT ISSUED--------------•---- - ---------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations----------------------- ---- -•----------------------------•---------------------------------------------...-•----------------------------- ---------------•-------------•-------------------------------------•---- -------------------------------------•-----------•----------------- ------------------ --- ------------ - --------------- -• - -----------------------------•-------------------------------------------------- -------------------- fZ 1 ------------------------------------ ----------- FINAL ----------- --- --------------------- /f/ FINAL INSPECTION BY: --------- Date _ SAN JOAQUIN LOCAL HEALTH DISTRICT 53 (doO) 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, Cali{arnia Tracy, California ES--9-2M 10-52 Revised W-2100