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L LLLt� APPLICATION FOR SANITATION PERMIT Permit No. .....t-S__ ±:Y` (Complete in Duplicate) — �V This Permit Expires 1 Year From Date Issued Date issued __v�l- -�___ Appication 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. i . a ��t �` JOB'AQDRESS AND LOCATION ' e ------------------------- - ---------------------- Owner's Name v--------------- -----------——-----f- toLvv__�------------- � �7.`_S"l Phone--A - Address Q-k-- -—7- I-------------------------------------0 --------------------------------------------- -------•--- — ----- Contractor' ---- Contractor's Name------•---- 0_!__I I.'gn-•---U)_k.!_1_)_�_�1 �--- I Phone��l A_39A1/ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel T Other ❑ Number of living units: __ Number of11bedrooms --";- Number of b6fhs ___ _._ Lot size -------- ----(LZ� Water Supply: Public system �ommunity system ❑ Private E] Depth to Water Table� ft. 3 Character of soil to a depth'of 3 feet:' Sand 0 Gravel E] Sa Fdy Loam E] Clay Loam [] Clay E] Adobe Hardpan ❑ Previous Application Made: Yes ❑ No E] New Construction:, Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - -t 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well -_ Q_ _ Distancerfrom foundation----1 ---------Mate iaf�---�P� I-'�Q_tot No. of compartments ___ Size P q yip---Liquid deyth-------- ---------------Capacity------ Disposal Field: Distance from nearest w II-�_��__�_Distance from foundat' A� Distance to nearest lot line---- Number i�---- �--- Number of lines___________-'__ ___________ Length of each line____ �_!_.� Width of french.______a__. j-.----_-_---.- U3 �T Type of filter material---- _P104- .,Depth of filer material..... _�__________Total length__.____ --------------------- Seepage Pit: Distance to nearest well_____________'_____:Distance from foundation--------------------Distance to nearest lot line________..____._ ❑ Number of pits----------------------Lining..material-----------------------Size: Diameter-----------------------Depth---.----------------------------- I Cesspool: Distance from nearest well----------- from foundation___________________ Lining material---------------------------_.________. ❑ Sze: Diameter--------------------- ---------- - --bepth--------------------------------- -------------Liquid Capacity----------- -------------.gals. Privy: Distance from nearest well----------------------------------_--------------Distance from nearest building__________.__--_----_________ ❑ Distance to nearest lot lirse."-"__ """'""`� �""`"`: ___ -••--------- -------------------------•------------------------------ Remodeling and/or repairing fdescribe_------------------------------------------------------------------------------------ ------------------------------------------------------- - -------------------------------------- -- i------------------------------------------------------------------------•------------ ------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will'bla-done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the<:San Joaquin Local Health District. --- -------- -- ------------------------------- --------------{Owner and/or Contractor) By: ------- ----------------------------1------ ---------------------------------------------(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 B {_ -�_--_ _ _ RATE r - a ------------ REVIEWED BY ----------- --_------------------------- -------------- DATE--------- ��r -6-O BUILDINGPERMIT ISSUED---------------------------------- -------------------------------------------------------- --------- DATE------------------------------ ------------------------------ Alterations and/or_.recommendations:t: ---,------°-------N..:_ .-Y`-°---------••-------------- - ---------------- ----•--------------------------------------------------------- ---- --------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTI Date........ ----- ------ ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 2M Revised V59 F.p.Ca. i ,