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APPLICATION FOR SANITATION PERMIT Permit No. ___1_Q_3_a-9 {Complete in Duplicated -� � Date 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. S49. llaxdll JOB ADDRESS AN.Q LOCATION....1-b -.La ---------� - = Owner's Name al.4J 'ti----- ---=-------------- -------------- Phone._------------------------- Address. = 010 ---------- i !/ i Contractor's Name -- �--- ------ -------------------- Phone _7-J__ 7 Installation will serve: Residence Q� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:-_:?__ Number of bedrooms_____ Number of baths J____ Lot size ._____________________________.__ t Water Supply: Public system [-I Commun'ity system R] Private ❑ Depth to Water Table _50.7-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 14 Hardpan ❑ Previous Application Made: Yes ❑ No K New Construction: Yes [A No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Septic (Noseptic tanksta cesspool permitted if public sewer is available within 200 feet.) ,q_�`-, p /� Distance from nearest well____j/D stance from foundation__._;<a______-___-Material__ +.-_'^'-Y- !--_____ ------ No. of compartments------2-----------------size-------3X(M _ -- - Liquid depth---:7-_�---------------Capacity.-- 0- Disposal Field: Distance from nearest well__, _Distance from foundation__./D.------------Distance to nearest lot line_1�_________. Number of lines------------------�.------- ----Length of each line------�'J _------------Width of trench------Zk ---------_---------_- Type of filter material-------OZ.4_ ___ Depth of filter material--- ff_--------------Total length_____ ----------------------------- i t: Distance to nearest well___1WoA(-e_____Distance from foundation___¢_____________Distance to nearest lot line_-$------------ Number --_ ____.._Number of pits-------- —_,___Lining material--- .0-C4__.Size: Diameter____!__l---_______Depth_____.__.__✓'`-_____________ Cesspool: Distance from nearest well-----------------Distance from foundation------------_-------Lining material--------_---__.______-_____________ ❑ Size: Diameter------ -------------=-----------------Depth----------------------------------------------------Liquid Capacity------------------ gals. _____________----------------Distance from nearest building-------------------------------Privy: ,"""`- Distance from nearest well___________________ ❑ Distance to nearest lot line. - -'----------------------------------------------------------------------------------------------------------------------- Remodelingand/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 r ordinan ces, State laws, and rules arAregulations of the San Joaquin ocal Health District. --- ---- -------------------------- --------------- Owner and/or Contractor (Signed -------- ---- ( ) By--------------------------- Title CJGri s - --- ---------------( )--------------- ------------------- ---------------- (Plot plan, showing size of lot, location of system in relation to wells, ildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCPTED BY____-__ _ - - -- ---------------------------------------------------------------------------- DATE----d1-2k -_5 ------------------------------ REVIEWED --------- - -- -REVIEWED BY--------------------------------------------- -------------------------------------------------------------------------------- DATE------------------------------------------------------------ 1 BUILDING PERMIT ISSUED--------------------------------------------------------------------------------- ---------- --------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------- ------------------------ ----- ----------------------------------------------------•---------------•------•---------------------------------------- ---------------------------------------------------•-----------------------------------------------•-------------------------•---------------------------•-------------------------------------=------------------------------ ----------------- ------------------------------ ----•--------------=------------------------------------------------------------------------------------------------------------------ ------------------------•- L Date---- J2------`------8---------------------------------------- FINAL INSPECTION BY:------- ,1! .�RA,^ `-------------------------- - '4�y 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 ES-9---2M , Revised 1.57 F.P.CQ.