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FOR OFFICE USE: Ck, L/ APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- __�.�.�.. •7� (Complete in Duplicate) ��• --- ---------------------------- - _---------------------- This Permit Expires 1 Year From Date Issued 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. 549. { JOB ADDRESS AND LOCATI N.... .. K lAIL----------------------------------------•---------------- ---------------- ...... ---------------------- -------------F---!:.Phone Owners Name QCs. .1Q/ ----_------ ----------------------- - Address------------•-- �51� � �+ ll?�---------• -= - ` Contractor's Name---------------- efre..- 0-0;5Zf --------------------------'----; �_ u�_,�.,--Phone.. Installation will serve: Residence [Apartment House ❑ Commercial [3 Trailer Court ❑ Motel"❑ Other ❑ Number of living units: __/__ Number of bedrooms r42,-_ Number of baths __I-__ Lot size. 1-36?----------------------------- I Water Supply: Public system Community system [-I - Private ❑ Depth to Water Table �eft.1 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑;, Adobe 2"O'Hardpan ❑ Previous Application Made: [if yes,date--------------------a No ❑ i ;New Coristruetion.:�Yes ❑, No [ '�1=HA/VA: Yes ❑ No ❑ 8v .L rte.-_ ."_tee._....-....��✓ rv.�Vr.;_t�, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.-)---W , �finents--------------------- --Size-•------------.��,--'-- - -----Li Material--`I-'---------------------------------------------- No. -----------------•------------- - ------ Se tic an iA Distance from nearest well-----------------Distance'front foundation-------------------- ��7 f�� No. of�compa J . __ E quid depth- -'. Capacity-------------------- _. Disposal Field: Distance from nearest well--- -----Distance.-from foundation _..!0140--------Distant e to nearest lot line---x�_-___ Number of lines------ l_ Length of each line-.-- ine -'- -0 II �� --------- --.W idt�h'�f trench---A-0 Type of filter materia--------- Q ---Depth of filter material___ ---___.Total length------- . Seepage Pit: Distance to nearest well--------. y___k_--Distance fr m foundation_______--_--Distance to nearest,lot line..-ti ----------- r3 ---__-- Number of pits material__ �AX-Size: Diameter.___,�.�--f.-i-.Depth_ !_______________ I T r Cesspool: Distance from nearest wellk_)._______1___Distance from founda+ion___.-._.__.____.--lining m,aterial-------Z____________________________ P U ❑ Size: Diameter-----------------------=--Y P. ---Liquid CaP�ty-------`--- gals. Privy: Distance from nearest well------------ -----------------------------------------------------Distance from nearest building__:_____. --________..._-_________--_. ❑ Distance to nearest lot"line------.... ----------- ---------------------------------------------------'--------''--------"------------------ -------- •Eri`..i------fes_"'"" ----- -- -----Y� "KO�'�""'"_ P ----. -- --- - ^' _ •"•------- « �= ------------ ------------ ---------- } I- =Remodeling and/or repairing [describe --- ---------------------------- - ------------------------------- ---------------------------------------------- -------------------------•--------------------------..------------------------.------- ----------- ------------------L i I hereby certify that I have prepared this application and that the work will be done in accorclance-with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin Local Health Districf4 r �.�, - + ' (Signed) � { r ---------•-------------• t---- ontractor) k By:------------ ------------•-------- ---------------------------- W-- --------•-------.(Title)--- ----- ---------------- (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be Eplaced on reverse-side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - ---------- 1 -----------------------------------1.----------- DATE------- r ---- ----------/----------------- REVIEWEDBY---------------------------------------- ---- ------------------------------------------------------------------•------ DATE-------------------- ----------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------- --------------------------------•------ ----------- DATE--------------------- --------------------------------------- Alterationsand/or recommendations---------------------------------------------- ---------•------------•------------••--------•-•---••---•------------------------ ------------------------------ --- -------•- -------- - ------ -- -- - -- I — _ - c-- c �- -- ------�-f--- � ------------------------------ ------ ------ - `" - -- z : --- FINAL INSPECTION\BY:---- � Date SAN JOAQUIN LOCAL-.HEALTH DISTRICT — %, 130 South American Street. 300 West Oak Street . ` 124'Sycomore Street, � 205 West 9th Street r Stockton,California Lodl,California i Marti ce a,Californid Tracy,California ES-9 R9V15EG e•59 F.P.ro.1M 6.00