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APPLICATION FOR SANITATION PERMIT Permit No. 4- -- {Com late in Duplicate) ,! P Date Issued .__7/---- n 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. JOBADDRESS A D LOCATION-------------- �- ------- l --------------• ----------------- --------------•---------------------------------------•------- Owner's Name__ o c v-I :� - V-- ----------------------------- " - --- ------------------------------ Phone-------- --"---------------•-------- p � ` �.• Address �v---- -'�' `------------------------•----------------------------------------------------------•------------------------------------------------ Contractor's Name- �_ _ - ----r—/--'- r- -----�----- - ----------------------------------------- --•--- Phone------------------------•---•-•---- i li`iillation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:/-._�_ Number of bedrooms ...___ Number of baths ___j__ Lot size -----��0---�_fG�----------------------------- Water Supply: Public system ❑I Community system ❑ Private ❑ Depth to Water Table _ o. ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes I- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: £ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,I ,_ Septic Tank: Distance from nearest well__/f/r?%c _Distance from foundation__/e___.______.Material--- G__C '- ___________________ 18 No, of compartments_._.__- ------------Size_-.. &---1 __36""Liquid depth__._6__0--------------Capacity----QCZ7 _.-.-___ r p, Disposal Field: Distance from nearest well.._Xlew Distance from foundation__: _.._____.Distance to nearest lot line___ _f__. T tr i' Number of lines-----------1_ ----=-------Length of each lin e---------#. ---------.Width of french.-----;!%0- -----------r----- Type of filter material._4�_.__S_�.""Depth of filter material-___ . _...______Total length___"__ �________. - r Seepage Pit: Distance to nearest well---?/d7-za_Distance from foundation____?_.__Distance to nearest lot_ line---2-f_l__- a � Number of pits----..--",,�----------Lining material__ -��ze: Diameter"__ 3,.�__..-_._Deptn.._._•..TQ_r �1�_.___ Cesspool: Distance from nearest well----------------- from foundation-----------------_Lining material-------------------------------------. Size: Diameter------------------------ -------------Depth-------------------------- ---------------------._Liquid Capacity----------------------------gals. 171 Size: from-nearest building Privy: Distance from nearest well----------------------------------�---- g-------------------------- ________________ w:� �� ❑ Distance to nearest lot line--------------------------- -----------------------•----------------------------------------•--------------------------------•-------- aRemodeling and/or repairing (describe): ---- --------------------------------------•-----------------------------------------------------------•-•---- -------------------------.-. 1 , ----...-----•--------------------------------------------•--- 1 ------------------------------- } I hereby certify that I have.!prepared this application and that the work will be done in accordance with San Joaquin County s ordinances, .State laws, and ruleand regulations of the San Joaquin Local Health District. u (Signed)------` • = --- ---------- -------------------------------------------------------------- ----------------------------- -----(Owner and/or Contractor) =€='----�-------'--- �-- 1.14 L �'� � sY� -- ---- ---- (Title)- a 4 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ----------------------------------------- DATE...... �-----------------------------------------' REVIEWEDBY-------------------------------- ------------ .......... ----- ----------- -------------------------------------------- DATE-------------5 ------------------------- ------- BUILDINGPERMIT ISSUED-------------------------------------- ----- ---------------------------------- DATE------ _ Alterations and/or recommenda+ions: - ------------------•--• -....._"" -------- ---- ---- ----- ------- . l .... --- ------------------ ------ � j � _ j;.. f ---------•- ------------------ ------ ----- -- --------- 4/0 FINAL INSPECTION BY:".__ ._�.( ----------------------------------- Date. --------------------------•------ 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 E5-9-2M .<sras n- 000 ;2- 4