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APPLICATION FOR SANITATION PERMIT rermif No. Z.V___l-- -.•- (Complete in Duplicate) Date Issued7_(_____ .t,. 9 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. JOB ADDRESS AND LOCATION_.______ Gv- 4 -� ----- -------------------------------------•--- -- Owner's Name -. z --- --------- ------------------------------------------- Phone_.. ��s-_ Address. ----•-------- �r CQ. ' .- .-- .� ------------------------------ - ------------------------------------------------- Contractor's Name. t > ��-------- - Phon ----------•- Q---4.- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___)_ Number of bedrooms __ Number of baths -/---- Lot size ------ Water Supply: Public system J< Community system ❑ Private ❑ Depth to Water Table _41/?7ft. Chariicter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Nf Hardpan ❑ Previous Application Made: Yes ❑ No >�_ New Construction: Yes ❑ No ❑ Su't TYPE OF INSTALLATION AND SPECIFICATIONS: _ I lei (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ir- Ta_4: , Distance from nearest well-----------------Distance from foundation--------------------Material S F FNo. of compartments--------------------_ - ---Size-------------- -- --------------Liquid depth--------- ------------- Capacity----------------------- Di osaf�eid Distance from nearest well---------- Distance from foundation___________________Distance to nearest lot line---------------_ Number of lines-----------------------------------Length of each line------------------------------Width of french Type of filter material-------------------------Dept material-----------------------Total length------------------------------------------ Seepape Pit: Distance to nearest well--t-4at4_je-------D tante f m oun a 'on--- - � _______.Distance to nearest lot line____ __--._ Number of pits------I___----_._ Lining mater �! _ _S' e: Diameter__ 0"r____-Depth_-- ' � Cesspool: Distance from nearest well-___-------------Distance�rom foundation-------------------- material-----------------___-____________.___ ❑ Size: Diameter-------------------------------------Depth-------------- -------------- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------- --_______-Distance from nearest building___--_____--_-_______.. O ----------- ------------------ Qistance to nearest lot line--------- ---------------------------------- ? Remodeling and/or repairing (describe)_-------_________________-__--------------__----------- ----•--------------------------•---------------------------------------------•------•----------------------------------------------------------- 0 ------------------------------------------•-----------------------•-------•-------------------------------------- 0- --------------------- ---- - ------------------ ---- ---- --------------------- ----------•-------------------•---------------------------------------------------•-------------------•------------------- I hereby ter ify a} I have repared is application and that the work will be done in accordance with San Joaquin County ordinances, State law ,f andrrules and reg ationsrof the San Joaquin Local Health District. (Signed) .✓f��l . . .... -- ---- 4 _` I Contractor) -- --------------------------- -- By:----------------- --••---------•------------•--------------------------•---------- 1 ..--------(Title)- ft'r Q. � (Plot plan, showing size of lot, location of system in relati to wells, buildings, fc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ----------------------- -------- DATE------ ---- ------ --------- REVIEWED BY --------------------- ---------------- -------- DATE-------------- -------------------•-------------------- BUILDING PERMIT ISSUED ------- ----------------------------------------------------- DATE------ -------------------- A terai•ions and/or recommendations----------------------------------- ---------------------------------------------------- - --------------------------------------- -------------------------- ---------------- ---- ---------------------------------------------- --------------------------------------------- FINAL INSPECTION BY:--------- Date--------------�-- l SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M , ' Revised W-2100