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A-1 APPLICATION FOR SANITATION PERMIT Permit No.,A 3�_____._.. r4 • - (Complete in Duplicate) ~Dafe 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. 706 ADDRESS AND LOCATION -�1 ND`---� Q Owner's Name---- zaw------d./e'l". �-------------------------------------------------------------------------- - ------ � �_�-- �---Address-------------------------- Phone___ q Contractors Name----------ai.44-----�---��/�L_�/R� --------��?----- - -------------------•------------ - - {---��Q-�------ Installation will serve: Residence (r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms --.,e Number of baths -L___ Lot size 8.Q ___� _ ________________________________ Water Supply: Public system ❑ Community system ❑ Private P?`*"5epth to Water Table 'g,<-- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0-11�ardpan ❑ Previous Application Made: Yes ❑ No Q-'INew Construction: Yes ❑ No ❑ 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----- Distance from foundation--------------------Material _______--__________________-____________-______. 10)(/Mr/-V 6No. of compartments------------ Size--------------------------------Liquid depth--------------------------Capacity------------------------ Disposal Field: Distance from nearest well Z74F----Distance from foundation---- 0----------Distance to nearest lot line;--—______— Number of lines--------------t_-w--------------Length of each line-----------C_�---_-__--.Width of trench----------2r!f _____---_-- Type of filter materic� --/ AGX---Depth of filter material___--- --------Total length_______________sem_*-- ------- Seepage _____ See a e Pit: Distance to nearest well____ CU___-----Distance from foundation____ p 9/ �Q_._.___.Dista��e to nearest lot line___!O_�___ Number of its__-_-_.-_____________Lining materval ��L� Size: Diameter---.%.33 Cesspool: Distance from nearest well__---------------Distance from foundation--------------------Lining material-------------------------------------- 1:1 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------ gals,, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------_------. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------- Remodeling and or repairing (ddees`criibe):....e0jA3rqAe$.A_AW_____Old'__ICKC-A--CIR IV-__�-IV��_!f�Y��.__.. / i! � '� � 4j.lt�•.�.rrfQ1�-T.._/.eY - a�GPTt�'----•----------------------------------------------------------------------- --------------------------------------------------------------------------------------•---•---------------------------------•-•--------------------------------------------------------•----•--------------------------------- 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. (Signed). a-A•-10: � - ----- -------------------------------_- ____________________(Omer and/or Contractor) -------------------- -- {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-- REVIEWED BY---------------------------- ------------------------------------------------------------------------ DATE------- ----�-•----------------------•------- -------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-- ------------ Alterations and/or recommendations------------------------------------------------------------------------ ------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- ---------------------------------------------------------------------------------------•----------------------•---------------------------------------------------------------------------------------------------------------•------------------------------------------------ ----------------------------------------------------------•------------------------------------------------------------------- ----------------------------------------------------------------------------- --------------- --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: Date --5-.- „'-------------------------------- 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 8-51 Revised W-2100