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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 3 �: p Date Issued _ __ __.___� ODO_. S /-EJ'C, Kc0,4C?,9btu Application 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. 5//49. JOBADDRESS AND LO TION-___- ._ _ - --t ---- �_. i- __..{� _.. -- .---- ------------------ir 1w ------------------- --------------------------------- ----------- ---• - Phone.Owner's Name l _&— Address tI ... - - -- -- ----------------- ---------•----------------- -- - ---------------------------•----..... Contractor's Name `+ = Pr/,0AC ---- -__ Phone-------•----------•-•-------------- Installation will serve: Residence Lj Apartment Ho se ❑ Commercial K Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ________ Number of baths _______ Lot size __/10_0----------- --------------------____________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tabled ft. { Character of soil to a depth of 3 feet: Sand ❑. Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 5k New Construction: Yes ® No ❑ FHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) V _ � r Sep Tank: Distance from nearest well 0_._ _ DaEfromfoun �}ion_ Q._ , -.Material---------- ----------------- _ _i_______ 49 _____-- apaty_._ _ _______________________No. ocompartments_.____.. - Ze � Liquid epth® C Disposal Field: Distance from nearest welll- Distance from foundation_, .�______.Distance to nearest lot line.- je t' t { Number of lines-_____�._____._ _ Length of each line----- ir'�____ __ Width of trench.._�_�__�,�______ ____________ Type of filter material_ _ � Depth of filter material____ Total length------14-4_ _........... Seepage Pit: Distance to nearest well_____________________Distance from foundation--------------.-___.Distance to nearest lot line_____-__________ ❑ Number of pits_____________________Lining material.___"__:--------Size: Diameter----- ---------Depth- .------------------------------ Cesspool: -------_-.-___-____________-Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material----------------------------------- El Size: Diameter----- -------------------------------Depth-------- -------------------------------------------Liquid Capacity----------------------------gals. C Privy: Distance from nearest well----------------------------------------------- from nearest building-------. _-________._____.___.____-- Distanceto nearest lot line---------------------------------- ----------------------------------------------- ---------------------- -------------- --I-------------- - - ---------/---------------------------------------•------- - ----------------------------I-------------------------------------------..- ---------•------------------• --------------------=-•---------------------------------- -----------------•..------------------------------ 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, arO ales and regulations of the San Joaquin Local Health District. \� (Si ned Contractor) 9 } c;; gY=---------------------•-•-•--- --- ------ ------------------ -------------------------------(Ti+le}------------------------------------ ------- ---------------- (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). D R ENT ` 5E ONL APPLICATION ACCEPTED BY.-_-- .. :--�----- ------------ -- ---- --- '°.`-'-"�� .r,•�--�;! �.��+°"�--- DATE----- �/,;. �?-• ------------ REVIEWEDBY--------------------------------------------- ---------------------------------------------------------------------- --.-.. DATE------- ----- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-----------------------------------------------------•---------------------------------------------.---------•_..--•-------------•---------- „ I i ------------------------- ----------------- _ _________ ______________________________________________»..____.____________-_-______-_._____-___._______.____._-____-__.______.___-_.____-_._____________---- ______ ____ _________________-__.________ _____.___ __-___ __ _______..__-___________.__________-__..__---_--_______.___..______..__________._____.k�.------------------------------------•------- FINAL INSPECTION BY:------ -------------__:_-- Date__..__ 1;>r; �_.._�_____. /Y 4 i _________________________ 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-9-21x1 • Revised 1.57 F.P,CO.