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II APPLICATION FOR SANITATION PERMIT Permit No. ------17 IIfW S4 ,i (Complete in Duplicate) Date Issued --- ---------- --- A licaion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described.p Thisapplicetion is made in compliance with County Ordinance No. 549. JOB ADDRESS'' ------------------- ---------- - AND L�AT10N_.. .r_`--=----==-�'- 0 l Owner's NameE Phone"- ! ""-""" 3 j . Phone---------------------------------- Contractor's Name.,,� ' z --------------------------------------------------- ----------------------------•---------------- Installation wilhserve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ! $ -� 3 54 ��-�f�! L Number of living units: .!-- Number of bedrooms -A . Number of baths """.""-_ Lot size _"-- ------ i Water Supply Public system ❑ Community system ❑ Private 0 Depth to Water Table ,/�'. ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 9 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [3 0 Previous Application Made: Yes [INo ] New Construction: YesK] No El -J TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �� ` �;, SeptictTank:_aw Distance from nearest well- --------Distance from fou dation--.��' ------.Material---4�'u!'�'""---------== ------ � n No. of compartments.....r�-----------------Size_-�"7-- "" ---�--•Liquid depth--- --- ------------Capacity-- 04X7=------ Disposal Fields Distance from nearest well -..-Distance from foundation--"."".. Distance to nearest lot line----------------- ------Length of each line------- --------------Width of trench---------------------- � ❑ ,j Number of lines----------------------------------- . s Depth of filter material----------------------'total length---------------------.•------------ Type of filter material----------------- Seepage Pit:; Distance to nearest well----------------------Distance from foundation--_---------.-------Distance to nearest lot line-_----..---_-_-- I Number of pits ------ -------------Lining material----------------------.Size: Diameter--------- -----------Depth-----------------------------•- ❑ ,I Cesspool: Distance from nearest well-----------------Distance from foundation.--- ---------------Lining ❑ :q: material--_--------".-.--.-.----____.------ Depth ----- De th-------------- ------------------- --------- -----Liquid Capacity-------------------------.gals. Size: Diameter--- ------------ ------------ --- . Privy: Distance from nearest well-__.....----".".-----_---------=-- Distance from nearest building ---------------- 1 ❑ �I Distance to nearest lot line--------------------------------------------------------------- ---------------------------------------------- ---------------- it a �� '� a^ -------•---- -•------ Remodeling and/or repairing (describe): "" '�'` ---- ------•----------•----- r0 •-------------------------------------- ----------- II --------------- ---•--------------------------•-- I here certify that I have prepared this application and-that the work will be done in accordance with San Joaquin County ordinances, State laws, and r le-s and regulations of the San Joaquin Local Health District. _ '-�<">•=a": --(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 U_5E ONLY tDATE---Z ---------------------------------------------------- APPLICATION ACCEPTED BY.../ - - ----------- ----- - - ----------- - - ---- REVIEWEDBY----------------------------------- --------------- -- ---------------------------------------------------------------- DATE----------------------•--------------------•------------- BUILDINGPERMIT ISSUED---------------------------------------------------- --------------------------------------------• - DATE--------------------------------------------------------------- - - ...--•-"-----------------------•-------- Alterations and/or recommendations-------------"-"--------- ""'"""" "" II ..-----"--"------------•--------•---•----------------------- --------------------------------------------------------------- -------------------------------------- ------- -------------•----------- -- ------------------------------------------------------------- FINAL INSPECTION BY:- Date ------------- ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. ES—9 145446 ATwoo❑