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X13 APPLICATION FOR SANITATION. . PERMIT Permit Nos, �,.... r' (Complete in Duplicate) �T xr Data Issued zplica4ion 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 ina No. 549. " JOB ADDRESS D LqPAT N;__"�"? _ l" #" -- ----- ------------- -- Name. ► a +---- ---------------•-------:------------------------------------------------------------------- ------- ------- ! s r - :'-- -------- e Address.............. - _ -----------•---------------------------------•-------------------------------- -- ----------------------------------- Contractor's Name----- - ------- . I - -- --- -------- ---------------------------- ------------------------ ---------------------- -------.......... Phone. Installation will serve: g.Residence Apartment House ❑ Commercial ❑ Trailer Court ❑' Motel ❑ Oth ❑ [ Number of living units: _+J--- Number of bedrooms .-,-____ Number o aths "-- Lot size _""� _ _____ __"_ 1 - y Water Supply: Public�sysfem ❑ Community system .❑_ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand Loam Clay Loam Clay�❑ Y � Y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: Yes [J No [r New Construction: Yes Na ❑ Y TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) [ [ Se tic a � Distance - _ from nearest well" _---------- Distance from foundation-__-- ---------------Mto erial 'No."of compartments"".. Size--- ---�- -�' -Li uid,de depth f . I l i q i? .._.-- - -----Capacity isposa iel Distance from nearest el -C��""--Distance from foundation" _ Distance to nearest lot line_ ,-�------ . Number of,lines' � �) " Length of each line___-----_-.-+ f Width of trench."-" T 'e or filter mater / : Yp ,�'�epth of filter maternal-----------f_- ----Total length----------- -------------- _ _ _ _e Seepage.Pi#: .' Distance to p earesf4_welCr_:-_________g D e aal e'from foundtiSize:n-iamete .Distance to-nearest lot line__-------_--_--_ ❑ Number of its------ -:_--Linin _ r-----------------------Depth Distance from nearest well------------------Distance from foundation--------------------Lining material"-_--------------_.❑ .7 Size: Diameter--"--------------------------- -=------De th_" - u"--- C ------------------ ------------- "" _ = Liquid Capacity " -gals. Privy:' Distance from nearest well----:--_--------------------------------------*__Distance from nearest building__ ` ❑ "' —Distance—to nearest:lot.line. ' « .—. l_ -�--. ' . ,+, ..e-. . ��. ...� � a ------ ----- - -- --- ----------- II • . . . - - ------------ Remodeling and/ora repairing (describe)------------------------------------------------ I e -- ---- ----• -• ---•• - ---------------------•-------- - s -------------- •--------.--- = t --.:------ •----"--•----------•---------------------------------•-------•---------------------------------. I hereby certify th t I have prepared this application and that the work will be done.in accordance with San Joaquin County:_ ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ........................ ---------------------(Owner and/or Contractor) - ---------=---•-•--------=------ ----------------------------------------- i----------_----------(Tits (Plot pian, 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 BY. ------ ----------------------------------- DATA """ ---- REVIEWED By---------------- - = DATE -::--------------- -- --- ----- ------------•--- BUILDING PERMIT ISSUED ------------------------ --=--------------------------- D.ATE------ Alterations and/or recommendations:-------------------------- _._ --------------•------------------------------------.----•---------------•-•--------- --------_--------------- - ----•--------•--•--------------------------------------- ----- -------- - ------------------------------------------------------------------ ----------------------------- ...:. ;•--- - --------------- -- ------- FINAL INSPECTION-By-------- —.• ✓ 2 ' -- -t---- -----•- -"------------------- ate-- ==----" SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Rev;sed W-2100