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II�1 APPLICATION FOR SANITATION PERMIT Permit No. ... _}.1 (Complete in Duplicate) -Date_Issued .....6.sS__� Applica+ion 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 LOCATION ��Y=— -.._•-------- Owner's Name.:__: i'd�7� - •--- ... ... '....._..... Phone Address_ ... � A. .�, p� ..�.* ._.....�.._.. ............. Phone Contractors Name.-_..- .__ ••. •. Installa+ion will serve: Residence �&_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�_... Number of bedrooms w.-'Number of baths _..-/. Lot size ................ X•/a-a.---•---••-----•------- Private ❑ Depth to Water Table �ft• Water Supply: Public system ,yCommunity .system ❑ , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ C* Loam ❑ Clay❑ Adobe 2 Hardpan❑ Previous Application Made: Yes ❑ No New Construction: Yes Ej_No ❑ " TYPE VOF INSTALLATION AND SPECIFICATIONS: " .(No septic tank or�esspool permitted if public sewer is available within 200 fee+.) Septic Ta k: j;;�, i from nearest well---.._._____-..Distance from foundation..........----------Material___....._.......__......_..__._._....__......... •---------------------- ❑ o compartments-•-----------------•- .Size : , Liquid depth.. - Capacity Disposal Field: ' isfance from nearest well.................Distance from foundation....................Distance to nearest lot line-------...---.--. Length of each line- ------------------- -....Depth ;.' ..Width of french-- ------------------------------•- ❑ Der of lines--_--------•---. ----- -- - g ype of filter material..................:...-.Depth of filter material......_..-,.......,-_-Total length.......................................... k, i istanc 'from foun ation_. �A___--..Distance to nearest lot line_.---___- Seepage Pit: Distance to nearest well...- �f !'Depth._._•f•�`--- g - ze: Dameter.-_._. {_ Number of pits--./--------_--.-• Linin maters Cesspool: Distance from nearest well..............'Distance from foundation__..:_........,_...Lining material...._.:................... ...___-___. C Size-'Diameter-------------------•--------- ----...Depth...................__..------. ----•.......:........Liquid Capacity-..----------- •-------- gals. 0 ❑ _._Distance.from nearest building Distance from 'nearest well.............:.:..........•••_-• Privy: = '�. ...........................•-........ ❑ - Distance to nearest lot line.':-.............................................•------ --------...-•--- --•-••....._.._.. x 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 County ordinances, State ; and rules and regulations of the San Joaquin Local Health District. . ` {S•s 9 ned) - ----•-��r/5-1•-----•S .. ...:...................••---------- _..... '.... ' (Owner and/or Contractor) r .. ---------- ------ By (Piot plan, showing size of lot, location of system in relation to.wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------ DATE. �.....' .............. ..- .......................................... .. APPLICATION ACCEPTED B ........ -• --- -------------'........_.. ....------..•....._.... DATE.... ..:....:... = REVIEWED BY_-...._ ------------------------------------ - --•--•---------- DATE........... .... .------••-•••...••••- BUILDING PERMIT ISSUED.....__. ------------------ -------- :................. 14Y ..._. ........... .. Alterations and/or,recommendations:_.....::........... ................. r' •� t-_--- --•............. e�S �- --- ............................................._ -� --....... •... ..... ll _ r HIL INSPECTION BY::::. :_: •:-.•.-.• . .: Date..::.E: �-�P...`.....- ------ .................•-...-•----... SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 914 North "C" Street 130 South American Street reeManteca, California Tracy, California Stockton, California loth, California rs—g 145444 wrWDDa r - -