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APPLICATION FOR SANITATION PERMIT permit No. _II__.... (Complete in Duplicate) { Date Issued ._-- L6_ .�--- ?'Aplica+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--------2 6 L �� A Al IS �& �y _ f •---•---••-----------------------------•---- Owner's -- -• Owner's Name---- e_?A ----••--- ------------- -------------------------------------------- Phone------------------------------------ Address ,"� -'�--S p- --- --- nn / q Contractor's Name � K- -�-5.�- - --Or-AL.$------------------------ Phone.4'10-._L.P_Y1-__(D6-7 Installation will serve: Residence A' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ *Number of living units: _/_____ Number of bedrooms J�_ Number of baths 1T- Lot size ----h_U_____X-/2T--_________-____-.__-_ Water Supply: Public system jjj Community system ❑ Private ❑ Depth to Water Table --- ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ AclobeA Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: a (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: �ta�tge from nearest well _-_Distance from foundation__________________.Material-_____________.__.-------_-.-______--_---------- No, compartments----------------------Size-------------------------- -----Liuid de th--------------- _ Capacity Disposal Field: ',9is a ..c,�e from nearest well_________________Distance from foundation______---________Distance to nearest lot line.-__________--. i [' um r of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Typ of filter material_-_._ ------------------Depth of filter material-__-------------------Total length---.-------------------------------------- Seepage _-_-____-._-_______________________-Seepage Pit: Distance to nearest well_-_-/Yd_/.1-__Distance fromud tion----c5:_g.f___.Distan�e to nearest lot line__j__ �______ I Number of pits-__._.l_____.___.___Lining material-Ac Diameter_-_. Depth------- _______ �`I Cesspool: Distance from nearest well-----------------Distance from foundation-..__...__ ----____ Lining material_ .___.-____--_.___-__ _ __..._ _______. O ❑ Size: Diameter--------------- ---.-Depth--------------------------------------------------------Liquid Capa it -------------- -------gals. Privy: Distance from nearest well.......------------------------------------------Distance from nearest building_--________-_--_________-.___.__._._____- , ❑ Distance to nearest lot line___________________ .,, Remodeling and/or repairing (describe):---------------------------------------------------------------------------------- --------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------••••--•- •------•-•------ ------------------------•------------------------------------------------ ---------------------------- --------------------------------------------•- ----•---•--------•---------••-------------------------------------------- = I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa a S, and rules and regulations of the San Joaquin Local Health District. r� (Signed)---------- -- ---- ---- --------- _'�Y `��—/' ------------------------------- ------------ -----------(Owner and/or Contractor) B _(Title)_ ___ _ [Plot plan, s owing 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---------Ste-'.-- �� -- - REVIEWED BY -----•------------------------------- ------ DATE------------------ BUILDING PERMIT ISSUED----------------------=-------------------------------------------- ------ ----.- DATE..---- ------••---• Alterations and/or recommendations:------- ---------- --------------------------- -----------------------------•--•--------------- ----------------------•.--------------------------------- S ----------------------------------- -----------------_--------------------_----___-----_--------___---------------------------_----------------------_----------------------------------------------_-------------------------------------------------------------- ---------------------------------------------------------__________________________________________________________________________________________________________________________________ ------.____._______._-_. FINAL INSPECTION BY: li-- ---------- ----------------------------------------- z�. 1 `=S..c ---------------- Date----------- _7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 Arw000 17-54