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APPLICATION FOR SANITATION PERMIT Permit Nra __-N__ .____-- F (Complete in Duplicate) - 11 f e ¢ Date Issued _5_ � S- ' Applica{ion is hereby made to the San Joaquin Local Health Dist ricf for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. k JOB ADDRESS AND LOCATION---•-•-------------SJ7-�S----------r------1 ' - o- _ 4 OwnersName - 5---•------•-•----------------------------- -- ------------------------------------ Phone ------------------------------------------ Address....-------------------- •...........- ; --------------------------------------------------------------------•--••--•-------•------------------------ Contractor's Name-.---------------------- - ----- �' ------------=---------------------------------------------------- Phone-•-----•----_------------------ Installation will serve: Residence Apartment House ❑ 'Commercial ❑. Trailer Court [I Motel 0 Other ❑ Number of living units: -------- Number of bedrooms __2___ Number of baths -------- Lot size ......../_S"0__`_____A'_____.�u8 Water Supply: Public;.systemCommunity system n Frivate f l depth"to Water Table ._y0' ft. Character of soil to a depth of 3 feet: Sand E] Gravel [-] Sandy Loam ❑ Clay Loam ❑ Clay Adobe Hard an Previous Application Made: Yes E] NoX New Construction: Ye No ❑TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tanVor cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well____r _' __Distance from foundation-------3- -----"Material--------I" - ----'_`..-:------_____. i N c�. of compartments--.--------I---------- Size------1--X_6-7Y_3-----Liquid del?th---------Y;.. ------..Capacity Disposal Field: Distance from nearest well _.._!;Tj---Distance from foundation_____ ____-Distance to nearest lot line------C-----_- Number of lines_____________� --- Length of each line_______-TO_--_--__-------Width of trench_--______fid _____._____-_- y Type of filter material__.___.___ j.----------Depth of filter material_______IV__------Total length----------- ______ ____________ � Seepage Pit: Distance to nearest well_'._._:---------------Distance from foundation----------_---------Distance to nearest lot line-____.___________ ❑ Nu`mber of pits------------------- Lining material-----------------------Size: Diameter.-----------------------Depth----------------------------------- Cesspool: ------- •---------Cesspool: Distance from nearest well_________________Distance from foundation -----------Lining material__._____._________.__________---____. f I Size: Diameter-------------------- -- !Depth--------------------------------------------- ------Liquid Capacity----------------------- -gals. Privy:j. Distance.-from nearest well-----------------------------------------------L._Distance from nearest building----------------------------- _-----------, �- I ❑ Distance to nearest lot'line___x__,______ ` "'" - - ------------------ --r----------------------------------------------------- Remodeling and/or repairing (describe):--------- --------------- -------------------------------------------------------------------------------------------------------------------------------- --------------------------------------i 3 _______________________________________________________________________________________________________________________________________________________________________________________________________________________________ t I hereby certify that Ihave;prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule, and regulations of the San Joaquin Local Health District. - (Signed).-_--_-1_a-- (l...f- --- -- - ---------------'--------- ------------------------ - -------------------------------------------------• ----------(Owner and/or Contractor) S E 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 APPLICATION ACCEPTED BY------------- ------ - --------------------------1/115-6 DATE-------------------- REVIEWED --=-------------- iREVIEWED BY------------------------=--:------------ ---------------------------------------------�---------- ------- --------- -------------------------- --------- DATE----------------------••----------- -------- ------------- i BUILDING PERMIT ISSUED------•--- •----•---------------------- DATE. Alterations and/or.recommendations:--- ------------------•------•---.----------••-----------------...---•--------------•------------•------.....-----•-•----•---------- -------------------------------•-•-----------------------------•--------- 1�U yep ------------------------ ---------- - -------- -- _ ,S ______________________________ _______ ____-_,_____•-___..____._._.__ - - - -- - -- ---- v . t FINAL INSPECTION BY:-___V1 ,fit t ------- ---- ------ - ---------- Date------_ __-- • -------- 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-9-2M Revised W-2100