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APPLICATION FOR SANITATION PERMIT Permit No. Al31. (Complete in Duplicate) Date Issued _/�/ 7:- -4S'y 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. 54�9./ JOB ADDRESS AND LOCATION 1_Y_- / G— Y-L7T' . ------------------------------------- --------- Owner's Name----/--1--L-=------ ------o---W I-jq �� f-C Phone - --------------------- - Address y -/ U-l--C CJ gam` � �--'---- ---�-a--��-�-------- ------------------------------------------------------------------------ Contractor's Name_--- --�)-Q_ ?----1--/-fl n_ j_/_ -- _ --%Y- -T_!.-�'t---- Phone---72.2-L --------- - ---------------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---Q Number of bedrooms ---0- Number of baths --L--- Lot size _-- _d�U--__X_--, --__-_--_-_---_-_--- Water Supply: Public system ,® Community system El Private E] Depth to Water Table _rT,�tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No R---New Construction: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ----___-__--_--_-___-_ ------------------------- ❑ No, of compartments___________________ ------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well---------------_.Distance from foundation__------ ------Distance to nearest lot line- Number of lines-----------------------------------Length of each line-----------------------------.Width of french----------------------------------- ____-- Type of filter material-------------------------Depth of filter material----________----______Total length____----__-__-_-____----___- ________-- Seepage Pit: Distance to nearest well__-_-_--_____-----_Distance from foundation-------------------Distance to nearest lot line----------------- El Number of pits---------------------Li ing material-----------------------Size: Diameter_______--- Depth,,----,, P ------pp Cesspool: Distance from neare . w II�-d Distance fro foundation---t1'_-.-__--___.Lining material-00-Ir Size: Diameter---- x 0----- __Depth---__-_ Liquid Capacity--- _--_-- --_-__gals. Privy: Distance from nearest well------------------------------------ -------------Distance from nearest building-------------------------- 171 Distance to nearest lot line Remodeling and/or repairing (describe)------------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin uin Count ordinances, �Slfafeules and' r ulat' of the San Joaquin Lacal Health District. (Signed)-- - ---- •------ - ----------- - ------------------------------------------------------------- ----------( r Contractor] By:------------------------------------------------------------------------------------------------------------------------------------(rtle)---------------------------------------------------------------- (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 Q -------- - ---------------- DATE------ ------------------------------------------------------------- ------------------- REVIEWED BY ------------------------------------------------- ----- DATE -------------- -- --------------------------------------- BUILDING PERMIT ISSUED-_ ------ --- --- - ---------------------------------------------------------- DATE Alteraflowand/or r mmendafons-- -------------- �---- 'v --- � _ ---- -------- ---------- ------------- -------------------- ------ f r h .� ---- --- ------ c' ----- lr_�------------ � x---�- -` -------- --------- `l �' ==---------------------------------------------------------------------------------------------------------------------------------------- ----- ---------------------------- -- ----------------------- ------------------------------------------------------------------------------------- FINAL INSPECTION ----------------- ate----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Was+ Oak Street 132 Sycamore Street 814 North "C" Street S+ocicton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100