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APPLICATION FOR SANITATION PERMIT Permit No. ......... ..... (Complete in Duplicate) yv { Date Issued ___._ �5 Tlication is hereby made to the San Joaquin Local Health District for permit to construct an pp y q p d install the work herein described. This application is made in compliance with County Ordinance No. 549, 1 JOB ADDRESS AND LOCATION..._- -rX`7d_ /d1-- = t e-�, } Owner's Name--------------- Address r------- ----------------- -------- ------------- Phone - `%_-_(fes - - Address r - --- ------------- Contractor's Name _-- 1 --- ------ Phone-----------�`---� Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ Number of living units: __/Num=er of bedrooms ._ 77Numbe� of baths __f___ Lot size ____.___ Q_'__2�_-.___l. -__'___-_..__ Water Supply: Public system �' Community system,❑;;, P6vate_❑_D'epth:ta.Water Table -_g ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ No X ew Construction-Y ❑ No ❑ ,� � yc� (\ TYPE OF INSTALLATION AND SPECIFiCATI ,.N (No septic tank or cesspool permitted,,if public sewer is available ithin 200 feet.) SVtic Tank: Distance from neares"r'wa11--------s!_ _Distance from foundation__________________.M,aterial____.________.____________.________ ______ Size No. of cornpartmen fse- -----------------------[Liquid pdepth---- � Capacity-------------- .../.� Disposal Field: Distance from nearest Iwell_�_ .bl� Distan�e from fa ncla ion____LZ__ _____D tante to nearest lot line______ _______ 19 Number of lines----- Length Length�of each line- ---- Width of trench----l5-•'---------- --------- Type of filter material'__a✓ _��2 .___Depth f filter materi+al______l_t-�_ sTotal length-----,-f1_'______________________._�\ �.�. \] Seepage Pit: Distance to nearest�well__jq&_d_a=_------Distance from foundation__1-0----------- to nearest lot line________ Number of its-_-/ - _---Lining, material__°° +_._ _ Size: Diamet ___--A3-'r______.Depth___.��'o---------------_--- Cesspool: Distance from nearest'well____ _____1Distance from foundation------_ _ inmg material-____------------------------ -- -- ❑ Size: Diameter------- i---::. t�epth------------------------------------------------- uid Capacity-------------- ------gals. r Privy: Distance from neaest well_________________________________________________Distance from tneare,i building------------------------------.------- - ❑ Distance to nearest lot line- ------ ------------------- --------------- - -------------------------�------------------------------------- - ---------------------------- Remodeling and/or repairing (describe)------------------------------------------------------------------------------------- -------- ---------------------------------------------------------- -------------------------------•-•---••----------------------•-----------• •---------------•------••--------------•-------•- ----------- ..-- - - -•---- t . I ------------------------ ------------------- --------------- �-------•-.-- ------------------------------------------------------------------ --- ----------------------------------------------- - --------- I hereby certify that I have prepared this 14plication and that the work will be done in accordance with San Joaquin County ordinances, Pal o laws, and rules and regulations gulations of the San Joaquin Local Health District. (Signe. i ned ¢- ___ .._ _ �or Contractor - -------------- ------------------ - --- Br• - - dr+le) c ---------------------- --- (Plot plan, showing size of lot, location of system in relatio to wells, build(gs, etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------------------------------- DATE- ----------------------------------------------------- -------------- REVIEWED BY------------------------- ------ -- -------------------------- -------------------------------------------- DATE-- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------ V=-- ----- -------------------------- Alterations and/or recommendations--- ----------------------------------- - ---- --------------------------------------- ---------•-----•-------------------------•------------------- ---------------------------------------------------------------------------------------- ---------- -------------------------------------------------------------- ----•------------------------------------------- ------------------------------------------------ ------------------------------------------------------------- •----------------------------------------------------------------------------- ------------------------------ FINAL INSPECTION BY:..------ Date 2- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street f300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California fffff Lodi, California Manfeca, California Tracy, California ES-9-2M 10-52 Revised W-2300 t