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a x APPLICATION FOR SANITATION PERMIT Permit No. liDuplicate) .___ ------ (Compete n upcate) �f r � Date Issued _j__q- -�.s qv-;V, C 7" pplication 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. ��.,,cc 4 JOB ADDRESS AND LOCATION--- __f_�__--�-- ------- d p+ ------ ------•4-,-.,s-)-------- Owner's Name----------------- ------------------------ Phone �£ �G - Address------- -- .r �C „-�-£� . E---- ---- -----• -----------•------------------------- - - ( f ; C ------------- Phone Contractors Name------ _.!-�.tl.------- --- --�-�i-) -�--- ---��-��1---' -�� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j--- Number of bedrooms _•.3'_. Number of baths _�__. Lot size ._- _�5- -/r__l SQ_._ •------- Water Supply: Public system ElCommunity system ElPrivate [�/Depth to Water Table3d_-ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam [IC-lay Loam ❑� Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No VNew Construction: Ye`s 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 well________________Distance from foundation_._____-______._._Material___-._-.________._..____.._____________._._-_.__ No. of compartments-------- -----------------Size----- --------------------- ---Liquid depth-------------------- - ---Capacity------------------ --- -- -- r' r Q_____..Distance to nearest lot line___-.____ Disposal Field: Distance from nearest well .___C1___.._ Distance from foundation_--_ _ _ f r d'— Number oii lines__ ______________,� Length of each line____ __COY--�'-Q-_ Width of trench._______--r.----.----------- Type of filter material_ [ _c_ryDepth' of filter material---/ _____----Total length........ID_ ____________________ Seepage Pit: Distance to nearest well-------------_--------Distance 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: Distance from nearest well-------------------------------------------------Distance from nearest building____-____._____-_____._____--------------. ' ❑ Distance to nearest lot line-- ----------------- - - -------•----------•------------------------------------- Remodeling and/or repairing (describe):----------- L� �"- ='� '{ '"L' `�------�-a-------------••--------•---------------------------.------------------ . -- --- - ------------------------------------ 4- ------•-•---- -------------------------- Y i I hereby certify that I have prepared thisofpplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Lac l Health District. {Signed} �k ¢/, "_.. ��1 - ---- -- -- - ---------- (Ow er and/ antractor) r -- -------------------------------- ------------ - --- ---------._--- Title--- --- - (Plot plan, showing size'of lot, location of system in relation to welds, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y -- DATE - - ------------------------------------------------------------ i REVIEWED BY-------------------------------- ----------------------------------------- !- --------------------- DATE BUILDINGPERMIT ISSUED--------------•--------------•------- --------------------------------•-•----------------••----------. DATE------- ---- ---,-_- ---- - Alterations and/or recommendations:------ --- ---------- ------------------ --------------•-------------------..:-----------=-------••--------------------E--------------------------------------- ------------------------------------------------------ --•----------------- --------•---------•--------- -----•------------ ------------------------------------•----------•--------------------•-------------------------------------------------------- --------------------------------------------------------•------------------------•-------- --------------------------------------------------------------------------- 1 FINAL INSPECTION BY_________________________ / �'✓ ------ Date---------- --- � - - ------------------------------ I ff 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 1 ES-9-2M 10-52 Revised W-2100