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�1 APPLICATION FOR SANITATION PERMIT Permit No. _ ._._ (Complete in Duplicate) J7i Date Issued ______ 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. pae ------•-•------._..._ JOB ADDRESS AND LOCATION-- A Z-4--t�--- �'1- IN --------- (/ Owner's Name-------- �• m._. - � ------- ----- Phone d �� y-- ------ Address----------------_--------- � �" --------------------------------------------------------..----------------- ------- -------••�-- w4 Contractor's Name--------- --- - -------------------•---- I-------------- --- ---------------------------- -------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L_- Number of bedrooms -_�.- Number of baths __f__- Lot size ---; _,s____��_��--^------------- Water Supply: Public system ❑ Community system ❑ Private epth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El,,Clay Loam ❑ Clay ❑ Adobe 2---Hardpan ❑. Previous Application Made: Yes ❑ No [ New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if puWic sMer is available within 200 feet.) �o � Septic T Distance from nearest we# Q.-_.Distance from foundation__f_ _..._.__.Material__C C_� 1. _________________ �V �� 4 No. of compartments--------------------Size- __-_-� - -------•-- Liquid depth--- t --------------Capacity_____ ` Disposal Field: Distance from nearest weli _�__Distanc!°e from oun ation____�_Q._r__-Distance to nearest lot line_I'��`_.__ Number of lines__-._/_____... Length of each line__ c�`--`-- -`::-'Width of trench..___`________________ i Type of filter materiaL_jf_r�?r��_ _____ Depth of filter material.... Total length____ __ ----_ Seepage t: Distance to nearest well. dp.°__..._._Distance fr fa ndation___��r____-Distance to nearest lot lins_----$ . R _ _ Number of pits._______._-_ .___Lining material--------- _.Size: Diameter.- _ ____-.-.__Deptn__. ___________________ Cesspool: Distance from nearest well---_-------------Distance from foundation------------.------ Lining material-------------------------------------- El Size: Diameter------ --------- - ------- -----.Depth------------------------------ ---------------------Liquid Capacity----------------------------gals. w f Privy: Distance from nearest well----------------------------- --- --Distance from nearest building-------------.----------------------------. ❑ Distance to nearest lot line----------------- - - ------- -----------------------------------------•-------------------------------------------------------------------- Remodelingand/or repairing (describe):--------------------- --- ----------------------------•------------------------------------------------------•-------------------------------------._..., --------••-----------•------------•-------•-------------------------------------•------------------------•-----•-----------------------------•- -----•------------------------------- n ----------- ------------------------------•----------------------------------------------•------------------ ------------------•----------------•-•-------•-------•--------••--•--------------•------•---------- ---------- ---------- ----- ---------------•----•-- -----------•-•---------•----------------- ----- ----•----------------=------------------------------------•-----•-----------------•-- I her Fe n, and arules pared + ' application a that 'he work will be done in accordance with San Joaquin County ordinances, d regulati s of +he Sa Joaquin Local Health District.Si ned ------ - ------------ ------------------------------ r-Contractor) { )-----------•----------- ------- ----- ---- ------- --- ----- B -------- ------------ -------------- ------------- - -_---------------- •- ------ ------(Title).�_tS'�I��Q�. Y� (Plot plan, showing size of lot, location of system in relati to wells, buildin , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATIONACCEPTED BY---- -------------------- ------------ --------------------------------------------------------- DATE------ �''------------- ------------------------------ lam` REVIEWEDBY------ ----------------------- - ---------------------- ----- ---------------------------- --------• DATE----- -- f BUILDING PERMIT ISSUED------------ - - -------- ------ ---------------•------------ ------ DATE. ------------- ---- ----- ---------------------- Alterations and/or recommendations:._.___.._____- -._ ___ -----------------•••-----•----- --•----1l� ........---- -----------•-•-'•---•---- -------------------- ------------------------ ----------- --------------------------------------------------------------------------- -- - ------------------ -----•-••------------------------•-----------•------------------------------------------------------------------'-------------------- ------------------------------------------------•----------------------------------------------------•-- --------------------------•----------------'--------------•-------•-------------------------------•------------•--------------------------------•-------------------------------------------------------------------------- _ FINAL INSPECTION BY:. —---------------------------------------- Date------------------------------ ;- - -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1 ES-9-2M 145445♦TWO06 12-54