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1� r APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) j Date Issued . -' ----'-/ 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. 549. " JOB ADDRESS AND LOCATION... �---�-- ---r' f�-f ---= - ----------------------------------------•---- ------------------------------------_ a i. s. ( F --- c Y{_J Phone__ "� •�. 1 r Owners Name-------------------- E -------. L- == ---------- c�1L — -----------------------------------------------------•----- Address---------- ----- --------•------...---------------• ---------------- ..------------------- ---------------- --------------------------- Contractor's Name------------------------------ �' ___VY s Phone...- Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /_____ umber of bedrooms - Number of baths _�----- Lot size ___ -/ - ----------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Lo;�No Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet. Septic T Distance from nearest well__N_�__Distance from foundation____.__ _ 0. -.Mat rial No. of compartments----n----------------Size---l_--x5----k ------Liquid depth--- -------------------Capacity----- 0 Disposal ield: Distance from neaLW well.-NOW----Distance from foundation__ _ ____- istante to nearest lot I�e__J____--_______ Number of lines__ r ,�-----.--- __Length of each line _4'�_.Width of trench__ _y____�________________ '// F 1� Type of filter materiay_ ,2j __Depth of filter material-__.__ ��_-__total length___.___ _�_ _____________________ Seepage Pit: Distance to nearest well_________________._-_Distance from foundation______-.._-__-_.___.Distance to nearest lot line__._---______- ( � ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-------.---------------Deptn--------------------------------- "J �: . Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining maferial-------------------------------------- n Size: Diameter--------------------------------------Qepth----------------------------------------------------Liquid Capacity-------------.--------------gals. `i?rivy: Distance from nearest well-------------------------------------------------Distance from nearest building------------_----------------------------. �Q Distance to nearest lot line--------------------- ------------------------------------------------------------------------ Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------- ---------- : . ----------------------- ----------•---------------------------•----------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 `ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. X[Signed)- �' C - ------ ---------------------------------------------------------------(Owner and/or Contractor) \ By:---------------------•----------------•-•-•------------------------ ------------------------------------------------=-------------(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 APPLICATION ACCEPTED BY---- --- - ------ -------------- ---------------------------------------- DATE--------------------n------ --- --- ----------------- REVIEWEDBY-------------------------------------------------- - - -- ----- -- ----------- ----------------------------------------- DATE------------- rj BUILDINGPERMIT ISSUED------------------------------- -- - -- - ------------------------------------------ ------ DATE---- ='- ----------------------------------------------- Alterations ------------------------------- Alterations and/or recommendations:------------- - --------------------------------------------------•------- ------------------------------------------• -- ------------ --- ,_ �---- -- --�;?s2rt--•--------- - - --- -- - ,rim----� --frr�'=�---t�'r'j _ _ ".�.1 - ----------- -------------- • -�'" . - p � --- --- - •--- - ------------''�- ------------- G r �r FINAL INSPECTION BY:------ __ ___ _ Date------ -----------------` 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 ..r ES-9-21x1 , Revised ;-57 F.P.CO.