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APPLICATION FOR SANITATION PERMIT' ^Umit No. ....G-�-. (Complete in Duplicate) 04` _: S- Date Issued -- - ----------- A ------- Applicaa-ion 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. JOB ADDRESS A D LOCATION- •-- --/- a---:fes- ----------- -------- -•- -- -------------------------------------------------------- Owner's Name -- --'---_C.._1..-•-- '7------------- ------••----. ..._.. - ---- Phone--- ••-------- ----- Address.--- ------------ -----------•-----•-------------- ----------- Contractor's Name-- �/✓- Phone =2 -i C Installation will serve: Residence 6--A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I__._ Number of bedrooms ---�_. Number of baths 1_�'L-,Lot size .--- -_____________________ Water Supply: Public system fl Community system ❑ Private 4-ghpth to Water Tables ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No [-New Construction: Yes n--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__;7j_._'_Distance from ffo1undation__._lQ---r_.MateriaL___ No. of com partments____.__�------..._.Si �7 a---Liquid depth-------4 - !1' ---- ----Capacity----6-Pll.-------- ze ____ _ Disposal Field: Distance from nearest well----7S- -.-_Distance from foundation____ _ �__�__.Distance to nearest lot line.___Pa_'_.__ Number of lines---------I--------/ Length of each line__ _ _______________Width of trench------�4.`!--------------- Type of filter material-.-- '.________Depth of filter material-_-___48_-...__.Total length--------X_ ---- ____________________ Seep ge Pit: Distance to nearest well____. _ _-_______Distance from foun ation...... []______.Distance to nearest lot Zine______ Number of pits---- ------------ ---Lining material___ Size: Diameter__3-------------Dept h....2-�'._________________ 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.----------------------------------------- -------------_---._____ Q ----------------- ❑ Distance to nearest lot line--------- ----------- ------•---- ---------------•--------------------------------------------------------------. a ---------------------------- Remodelingand/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, St a law and rul s and re ulations of th San Joaquin Local Health District. (Signed) ---------- ( ontractor) 8y --- . . ---- -- ?--!!% �'xae�- ---- -�------------------------------------------------------(Titlel 'g`.-s lr '----------------- (Plot plan, s owing 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- --5;�-------------------------------------------------- REVIEWED ------ - --------------------------------- REVIEWEDBY---------------------------------- --- ---------------------------------------------------------- --------- DATE-- ---- ---- - BUILDING PERMIT ISSUED --------- ------------ DATE------- -- � --------------------- Alterations and/or recommendations:----------- -••----------- �1� C ----------- I --------- ------------------------------------ ------------------------------------------------------------------ ------------------------------------------------------------------------•----------------------------------------•--- ---------------------------------------- ------- ---------•-----------------------------------------------------•------------- - ---------- ------------------------------•-----------•----------------------------------- FINAL INSPECTION BY: 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 E8-9-21A 145446 ATWPab 1 S-