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Permit No. �"'. ^� - APPLICATION FOR SANITATION PERMIT !� q + {� (Complete in Duplicate) 1 { Date Issued Application is hereby made to the San Joaquin Local Health District for a permit t struct and install the work herein described. I This application is made in compliance with County Ordinance No. 549. q--4A. �----- ~------------ ---------------------- ----=-- JOB ADDRESS AND LOCATION------ ----------------------------- 4--L.r . `. r M (� C� rl i- Owner's Name--------------�'`- -a--- -------- _ Phone----------------- -I �£ ------------- ---- Address--------�►-t--- 4z)-x--- �N--------------------------��t,2-L°hf Q�-----------------------------------------------••-------------------------------- Contractor's Name---------- ---•- -- Phone----------------------------------- - - --------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ --_ Number of'hec�rooms-' " Number of baths J------ Lot size ____ d-D-f--- -- �� Number of living units: __.a✓ ��--�7_ Pi Water Supply: Public system ❑ Community system '❑ Private [' Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe el' Hardpan ❑ Previous Application Made: Yes ❑ No Er New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well--- ,from oundation__ __ p a,�� ------ Mate ial X-e-' -w-a-erI;- ^----- No. of comparim 5 Sizex .t Liquid depth -Capacity 4 r 5 - Disposal Field: Distance from nearest well_--efe------Distance from foundation_ _ -------- Distance to nearest lot line-- Number of lines----------�------ ---- -----Length of each line--- - - -�---.Width of trench------ `�- ---r------------- Type of filter material_ _ o4`---Depth of filter material_____--r--____--Total length--______--/-Zl---------------- Seepage Pit: • Distance to nearest well---------------------- from foundation---________________Distance to nearest lot line----_____---____. ❑ Number of pits----------------------Lining material_:,--------------------Size: Diameter-----------------------Depth---------------------------- -- . Cesspool: Distance from nearest well__--_________-_Distance from foundation___________________ Lining material---________-______--______-----_____-. ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy:-4 Distance from nearest+wellfrom - ---------------------------- '�stance nea;`rest buil ing___------__-_ ❑ 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 ordinances, State laws, and rules and regulationj of the San Joaquin Local Health District. Z--- ------------------------ -----------------(Owner and/or Contractor) (Signed}_ _ - ---- - ------------ ----- 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 V- APPLICATION ACCEPTED BY------- --------- - "-r-- . "-f DATE REVIEWED BY _ = DATE------------------ --------------------------------------- -----------------------------------------= -------------°-------- BUILDING PERMIT ISSUED--------------------------------------------------------------- DATE Alterations and/or recommendations:--------------------- -- ------------- -------- --------------------------------------- ---------------•----------•---------------i��-------------------- - ------------ ------------ -- t ---------------- --------------------------------- -- -------- _ ------ - -------------/------- j � ,�/' � f,, � { - -- -----f__4-1t-r-------�,''-= ----------------- -'rye'- '�'�-------- ------ �^°v---- g_ " i ----r-=. -"-------------------Z--------3------------------------ --------- "" ` ---- 4 � ''� �----- �CP-r _o�r*-� -�GfkF 1 � Date-------------------- --� .�- �---------------- FINAL INSPECTION BY:------------------��-- --4 -P �' - - "� W-e^.. 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 B-51 Revised W-2100 1