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111�1C3b 7 APPLICATION FOR SANITATION PERMIT Permit No. ___.. -� -r. .. (Complete in Duplicate) 1'�� - Date Issued _��_{�� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein escribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L CATION- !_r --------V("�- --- - ----------------- Axk6 Owner's Name---------� - -S------ ------------------------------ Phone---��=a---y ------------------ - Contractor's Name _.�#� - - - - ----- Phona --- a Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: __`_____ Number of bedrooms ��__ Number of baths ____L Lot size -----)-5A--Y ------------------------------------- Water Supply: Public system Community system ❑ Private ❑.,,,Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes P� No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.)f Septic Tank: Distance from nearest well-`79,. -h� -Distance from foundation---/A----------Material-_--_ i3� ____-.-__--. ] No. of compartments----7------------------Size____9_X_3_�:'j---•---Liquid depth----�------------------Capacity___ -------- i DISKI Field: Distance from nearest welDL^Jk.,_.._.Distance from foundation__l0------------Distance to nearest lot line.��------- ! Number of lines_________ ___ _____________Length of each line7Wy_34.3Qy30.Width of trench.-_2Y-(__________.__.----_--_- Type of filter material_ S:V, -------Depth of filter material_--_-��_________._Total length__ J_84----------------------•---__ ( , Seepage Pit: Distance to nearest well-----___--------------Distance from foundation-------------------.Distance to nearest lot line____-__________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h---------.----------------- - -- \ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.-----------____.____-.___. ❑ Size: Diameter---------- ---- ------Depth-.---------------------------- ---------------------Liquid Capacity----------------------------gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ Distance - ---------------------------- Distance to nearest lot line--------------------------------------------------------------------- Remodeling and/or repairing (describ ) e ---- �---A,�Cl.1r ------- .,,� f -s ------- --------------------------------------- ------ ----- N .�`r �y Lt ..Y-� ------C---------- - --- - -- ( ,. ----- --- ------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------ - -- - - I hereby certify that I have prepared this application and that the work will be done in accordance with,San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Sig ned)_!s,/W_L✓el� ---------------- ) I ____(Owner and/or Contractor Br:- ----------------------------------------------------------------------------------- -----------------------------------------(Title)----------------=------------------------------------------- (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 BY--- - �44L. -- - --------------------------------------------------------- DATE--' p.. . ------ 1 REVIEWED BY - - -- DATE- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:- ------- ----------- - ------------ ------ - -- ' v . �._ ----------•-----------•-----------------------• ------------------------------------------------------------------------------------ -------- ------------------------------------------------------------------------ ----------------------------- - 1 f r FINAL INSPECTION BY: -----------•-- Date------1-_! J-3----------�------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9---2M , Revised 1-57 F.P.CQ- J