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tA 2,, APPLICATION FOR SANITATION PERMIT Permit No. .__1_ _. ..J_.. in Duplicate)(Complete p ) Date Issued ......... 1 Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATION------- �'`�---`---�----------� E�1 C" � ------------.4a Owner's Name_.______ r Y `� r one. - ------- --- ��' Address. �` Tr—•'K�G+�:, � C - ------------- -•••- -- •. Contractor's Name-------- '=�...... ---------------------------------------------------------------------- Phone------------------. -------------- Installation will serve: Resid' ce JM� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�---- Number of bedrooms ---E!--- Number of baths ___(__-. Lot size __ __ _L __ _____________________________ Water Supply: Public system ❑ Community system] Private ❑ Depth toWater Table _ b ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel\❑ Sandy Loam ❑ Clay Loam ❑ Clay [)� Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No�T New Construction: YeXj No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic,Tank: Distance from nearest welly -__� ' tante from foundation U____-.Ma erigL_-___ `�� '�___. No. of compartments__'-:______ Size__ ..1�-_ 1._ ._..Liquid depth-_._ __-71--_Capacity..-g__ __.____ " Disko l Field: Distance from nearest well G� c_: -__ istance from foundation...'.�_0 -....Distance to nearest I t 1'ne__ Number of lines_-__ ______ __ - {i \ _ '___ �________ ____Length of each line--14___-_.],._► ___-Width of trench___,_ ___ ____________________ Type of filter material_� i` _ -__-Depth of filter material__ `------------Total length-----_� _______________________ Seepage Pit: Distance to nearest well_-------------------Distance from foundation....................Distance to nearest lot line___________-_____ ❑ Number of pits______________________Lining material_-_______-_____..______Size: Diameter-----------------------Dept h---------.___________.___________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-_________________-_-__-___________. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity------------------------•---gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_________________________-_______________- \� . ❑ Distance to nearest lot line----------------------------------------------- -------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------------•---------------------------------•------------•---------------------------------------------_- ------------------- -------------------------------•------------------------------•---------------------------------------------------------------------------------------------------------------•-------------------------------------------- ---------------------------------- ----- ------- ----- --------------------------------------------------------------------------------------------•------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance a laws, and rule' a 'regullaatlons of the San Joaquin Local Health District. (Signed) - ------------------------------ ------ -(Owner and/or Contractor) Ely:'117e1 �ZS' :-Z�.� ---------------------------------- ------------------ -----(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------------------------------ ------------------------------------------------------------------ DATE------- - -- ----- ------------ REVIEWEDBY---------------------------------------------------------- -- --- -- -- ------- -------- - DATE........ -` - ----_------------- BUILDING ------- ------BUILDING PERMIT ISSUED--------------------------------- - DATE-------------------------------------------- ----------- Alterations and/or recommendations:--------------- --------------------------- -•------------------------------------------------------------------------------------------------------------- ----------------- -------------------------------------------------------------------------------•---•----•••------------•-------••--...---•--......-------•--••- ---------------------------------•-------------------------------------------------------------------------------..................................................... -------------•-----._.-----------------------••-•••- ----------------------------------------------------------------------------------------------------------------------------------------------------------- -------- ----------------------------------------•---••------- -------------------------- -------------------- --- -----•-- ------ ------ ------------------------------------------------------------------------------------- ----------------------------------- FINAL INSPECTION BY------- ------- — :----G ----------- 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 1.57 F.P.CO.