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P Ii APPLICATION FOR SANITATION PERMIT Permit No.`o. - "�...... I� (Complete in Duplicate) Date Issued XAica+ion is hereby made t 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. s JOB ADDRESS AND �OCATI N.3. -� Q --------------- -------------- -------------------------------------- ------------ Owner's Name---l.l_4s _ .�------ ---.W- ------ --------------- Phone.---•-----------------------_...__ Address - -- � :��' __..._. � ----a. -1 -----------------------------------------••---------------------------...-----------------------..._..------ Contractor's Name---- � --•---------------------•------------------ Phone----------------------------------- Installation ---..-.----------------- -•---•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 ❑ Community system Private ❑ Depth to'Water Table ________ ft. t Character of soil to a depth lof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: ,Yes ❑ NajZ[ New Construction: Yes ❑ No1� �M TYPE OF INSTALLATION A'ND SPECIFICATIONS: { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance,from nearest weII N_6,1h)_PDistance from foundation__ _. " /Q.----------.Material-------- -x&6- -- ------� 4�rr� P c;� X Liquid depth T P6-----No. of com artments.______._- size_____ Ca a 9is -s l[Fie dd:J °� Tance from nearest well__A&�/�f�)istance from foundation___�Cl __..____.Distance to nearest lot line___________ W # _ �kz� ber of lines.--. ---------- ------Length of each line------------------------------Width of french----------------------------- Ah'! Type of filter material-------------------------Depth of filter material------------------------Total length---........•..-.---------------------...__ Seepage Pit: Distance Fto nearest well.__________ ___ p -_____Distance from foundation---------------------Distance to nearest lot line----------------- ❑ _ _ Number of pits----------------------Lining material--------------.--------Size: Diameter-----------------.-----Depth----------------------..--_--.-._ t Cesspool: Disfance"from nearest well------------------Distance from foundation--------------------Lining material__.-_____..__._____________________- 3 ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity- -------------------------gals. Privy: t Distance.'"from nearest well----------------------------------- -------------Distance from nearest building------_------.----------------------.----- ❑ Distance'��to nearest lot line------- . e doling, n or, repairing (describe): --- - - --- --- ---- - -- .. `"'`�---- - -------------•----•---- �r. . . -------- .......1----- ---------•--•------- ----------------------------------------...-------------•-•------.......-------•------------------------------------------------------------ --------! hereb---certif---the+---h------ --•------------------- ----------------••----------------------•---•--•------------•-•--•-•------------------- .... ------------------------------------ y y prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a ws, and rules an regulations o the San Joaquin Local Health District. /� !�'� __Ot.l -------------------------(Owner and/or Contractor) {Signed} i By--------- ----------------- I� ----- {Ti+le)------------••------_I--------------_------_---------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �i j' FOR DEPARTMENT USE ONLY .w. APPLICATION ACCEPTED 'BY----------------- --- •---------------------- ------ DATE---- ----------------------------------------------- w ---------------------- REVIEWED BY------------•---------�`-------------------- -- - ----- DATE -- REVIEWED BUILDING PERMIT ISSUED-.----------------------------- - DATE--------------- ----- ------------------------- Alterations and/or r corpme_ndations� ._ - ........ _ ._ `'� ..------- - =� �. �� -------=---- - ----------------- ------- ------- �--------------------------- ---------------------------------- --.------------------------------------- ----------------- -----------•'-------•-----------..--------------------------- -- ----.. _ dl ------ - :,i -- --------- ----- ----------------------------- ------------------ ----------------•=-•-----------------------------------•---------•-------------------------- FINAL INSPECTION BY.�� = Date-----n------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street! 300 West Oak Street •132 Sycamore Street 814 North "C" Scree! Stockton, California i Lodi, California Manteca, California Tracy, California ii E5-9-2M 145446)4TW09D 12-54 \ II