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APPLICATION FOR SANITATION PERMIT Permit No.s---1-.C 1 , (Complete in Duplicate) i `� � Date Issuedl .. 1 Applica*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 AND LOCATION_________............. _- D_-- "� - -----9-4-----— ------------------•-------------•------------- Owner's Name.____ ir�-�- c/ - ---------- ------ Phone ----------------------- Address_____________ ' A-1—.�'�a. ----- ---------------•- Contractor s Name---- � ** - ---------------- Phone. 0 j `�-!! Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Gurt ❑ Motel ❑ Other ❑ Number of living units: ----1- Number of bedrooms -- Number of baths I---- Lot size ______;Z �y �-.�.. Water Supply: Public system ❑ "Community system ❑ Private 590-OT—Pth to Water Tableft. Character of soil to a depth of 3 feet: - Sand 0 Gravel ❑ Sandy Loam Clay Loam ❑ Clay [1 Adobe and an �� L p ❑ Previous Application Made: Yes ❑ No 9— New Construction: Yes L— IVo ❑ e 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___�i_0--`.__Distance from foundation_____i��-,__.__.Material_. ' --------------- i •--------- �--- No, of compartments__»:___._- .._____.__Size_ _ .____ __ oLiquidp - 'p „ (� �--�- ----------- de th----y-�•'- -----------CapacEtY---©--�------- -Disposal Field: Distance from nearest well__-.®---`. Distance from foundation___--e-Q_'---...Distance to nearest lot line___ 0 r Ne w umber of lines--------------�- Length of each line------- {, -------_-_--.Width of:trench_-..Z__ ----------------------- Type of filter material-_�(-�---- Depth of filter material____._1I:."_-.Total length------9,,_:9,3_1 Pit: Distance to nearest ___Distance from foundation______-P�r'__.Distance to nearest lot line- Number of pit,__:I__,�------------Lining material___--Size: Diameter-.-"-"'_- -_De th__- * "� p F =10------------------ - Cesspool: Dis#anc, from.nearest well_____'-_______Distance from foundation_____..____..__- _Lining material__._----_--------------- • t r ___________. ❑ Size:'Diameter---r'___________ _ - Depth Liquid Capacity.. ----gals. Privy:' Distance from nearest welt______________ ______________Distance from nearest building . El Distance to nearest lot line___..._-------_ -- - -------------------------- Remodeling and/or repairing (describe):________________________________ ----•---------•-----------------•----- ----•-----------------------------•-----------•-----------------------------------------•---------------•-------•-•-------------I---------------------------------------------------- � £ it 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, and rules and regulations of the San Joaquin Local Health District. At. 9 f+ 1 •� (Signed) -- ---- ----------- --- _ Contractor) w C or 13Y:------- --- ---------------------------------------------(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 9 1 APPLICATION AC(fI_PFTED BY --------------- ------ - ----•------- DATE--------- � -� -------- ------ REVIEWED BY-------------------------- `4 --------------- -------------------------------------------------------------------------- DATE---------- --- -----•------------•------------- - BUILDING PERMIT ISSUED------------- --------••--------------------- ------------ DATE---------------------- Alteration's and/or recommendations:_�__---------- ------------------------------------------------------------------------------------------------------------- ______ -----•------------------•---------------- ----- ----------- ----------------------------•-------- ••- ------•------------- _ -------•----------------------------------- ------------------ ------ FINAL INSPECTION BY:._--_......_ ry� !/v Date... . Y. - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norfh "C" Street Stockton, California { Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2)00