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------ APPLICATION FOR SANITATION PERMIT Permit No. . -.1---------------- APP } n/ (Complete in Duplicate[ , Date Issued ._-- -�-�---------- +• w b made to the San Joaquin Local Health District for a permit to construct and install the work herein described.. P'PApplica ion is hereby This application is made in compliance with County Ordinance No. 549. •--------------- -------------------- -------- JOB ADDRESS AND LOCATION.. \, ----- -------- Phone. ` Owners Name. __ --•-- --�--- L.J Address----------------•--�'-��•--+-- ---- ��--- -----------•--------------------------------...------------•---------------------••---------------••-------------.. Contractor's Name... .......... . �-/-----••------•--------------------- Phone --�[9/Apartment House Commercial -- Trailer Court ❑ Motel ❑ Othe ❑ ri Installation will serve: Residence [9 Apar ❑ �� ff � -------------- ., Number of living units: __/___ umber of bedrooms _ .- Number of baths -_l__._ Lot size ----- .-_- Water Supply: Public system Community sys+em❑ 'Private ❑- Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand l] Gravel ElSandy loam EJ/Clay Loam F1Clay E] Adobe ff'.'/Hardpan ❑ Previous Application Made: Yes ❑ No [aE] New Construction: Yes MOO'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer,"is availablewithinhi a 200 feel.) Mate i __1:��-�._____..___.__...;___-_...�_____. �, Septic Tank: Distance from nearest wel11`vf/-___. ----t stance fro j No. of compartments-____-- - +- - . _+--Li uidfde th__'----- - Ca aci OV - Size q P. P ty •¢ f ��i g S �r� Distance to nearest fot lih Dispos '1 Field: Distance from nearest well -Distance -romAu-ndation___�__._... . e`1 -- � _._ g 4� ri---.Width of trench._---�._�+_.'_-_-- LJ Number of lines_________ F Length of each line_____________ ; Type of filter materi ______..._Depth of filter material........ . . .....Total length__..______�__ _Q________________ Seepage Pit: Distance to nearest well------------------------Distance from foundation-------------------- Distance to nearest lot line_________________ Number of pits--------------- '-Lining material---------- ------------Size: Diameter.................. ....Depth---------- ---------------------- Cesspool:, Distance from nearest well------_----------Distance from foundation-.------------------Lining material---------------------------._____. 11Size: Diameter----- ------------ -------------- Depth-------------------------------------------------------------- -------------Liquid Capacity------------------- ------gals. \, t .___._Distance from nearest buildih '"' ._ Privy:- Distance from nearest well ------ ----- g--------- -- ----------...-------------- ❑ 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 ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Owner and/or Contractor (Signed _ L=-j _;-�--- - --------------------•----- -------- ---------[ ,/ I B :-------- ----------- ------------------------------ (Plot ----------------------------- (Title) (Plot plan showing size of lot, location of system in relation to wells, buildings, a#c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-'4,.-------- -- ------- ---- ----------- -- -------------------- ----------------- DATE_ REVIEWEDBy...............--------------�;f h... ---------------- ------------ -------------------------- ----- DATE----a--------•----------------------------=---------- DATE-------1%1*1 - rBUILDING PERMIT ISSUED------ v------------------------------------------------------------------ �-------------------------------- -_ Alterations and/or recommendations: - ------ -- --------------- ---------------------••----------------------------•------------------------------• --------------------------- - - - Ts - - '� --------------- -------------------------------------•-------------------- ----------------------------- - -------------------- - -------------------------------------------------------------- INSPECTION BY:. ------------ Date. -: - - -- ----------------------- 1 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 I � ES-9-2M 1x5446 ATW[][]o 1254