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APPLICATION FOR SANITATION PERMIT Permit No--3_. ....... (Complete-in Duplicate) I -e�v�� Date Issued fr!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 N4 549. JOB ADDRESS AND L TION - -,I<----- ---- -------- -----__ --- - ------- �Ll------------------ Owner's Name---------- - --------- --- ------ ----- ------------------------ Phone__ ------ --- Address... - ------------- --------------------------1---------------------------------------------------------------------- . -------------------- -- - Contractor's Name___________________- --------- - -----/-------- ---- ----- __1--------------------------------------- Phone____------ Installation will serve: Residence Apartment House ornmercial E] Trailer Court [] Motel E] Other ED 9 ---- Lot size ---- IgI.Fep- Number of living units: Number of bedrooms Number of baths -/ n r_1401 Water Supply: Public system El Community system El Private x Depth to Wafer Table t. Character of soil to a depth"of 3 feet: Sand E] Gravel E] Sandy Loam pa",Clay Loam [I 'Clay El Adobe Hardpan E] Previous Application Made: Yes E] N New Construction: Yes Rf No OA/ 's TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weii-----------------Distance from foundation--------------------Material------------------------------------- - ------ No. of compartments-_.-_"______..._- " --- -Size-.------------------------------Liquid depth--------------- ---------Capacity---------------------- , Disposal Fiel&/ V-��111Vor, Distance from nearest well-_.____..._-----Distance from foundation--------------------Distance to nearest lot line____.---_________ ---------------- ---------- Number I lines--------- -------------------------Length of each line -- ..Width of trench-------------------------------••- IX : Type of filter material-_-----_ ---- Depth of filter.,.material-----------------------Total length-------------------------------------- Seepage Pit: Distance to nearest __-_Djs�anc;(,_.,�rn joydation----//,))____.D',sfance to nearest lot lin 6rr material�_ _ Size. Diamefei-a2."--------Depth_ ZZ- ------- - Number of pits.__.____ --------- ing mafe I Z-- ---- Cesspool: Distance from nearest-well------------------Distance from foundation--------------------Lining material------------------------------------- ----Depth -------------Liquid Capacity----------r-----------------gals. El Size: Diameter------------------ --------------- Privy: Distance from rear-est well-------------------------------------------------Distance from neareo building-------------------------------------- n Distance to nearest lot line----- ----------1------------I------------ Remodeling and/or repairing (describe):: ------------------- ------------------------------------------------------- -------- --------------------------------------------------------------------------------------------------------------- -------- -------------------- ----------------------------------------------------I-------------------------------------------------------I-------------------------------- -------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------1-1--------------------I -------------------------------------------------- ------------------ ------------ ----------- --------- ------------------------------------ ------------------------------------------------------------ -------- ----------- ---------- ---------I-_her-e-b-y-_certify_that- - -_I- have -prepared- - --_this.application and that the work will be done in accordance with San Joaquin County ordinances, State I and rules and regula '.ons of the San Joaquin Local Health District. Contractor) d or (Signed)------ ----- l k --------P---------------- -----(Owner an----------------I---------------------------- --------- - By------------------ ---------- W... ----------------------------- -----------------------------------------mfle� --- - - ----- (Plot plan, showing size o t, location of system in relation to wells, buildings, etc., can be d on reversesi[K- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -J------------------------------------..$. ----------------------------------------------------- DATE___. REVIEWED B - DATE__-.-- --------------------------------------------------_---------------------------------- -- DA E BUILDING PERMIT ISSUED --------------------- ------------------------------r--------------------------------- DATE----- -------------------------- ------------ Alterations and/or recommendations:-------------------------------------------- ---------•--------------------------•-------•----------•------------•------".------ ----------------------- Ale --------------------- •-- ------------- ------------------ --------------------------------- -------------------_-------- ...... --- ---------------------------------- ------- ---------------------- 71, �V, * 4 ------------rr --I--------- - - ------ ----- ---------------- ---------- --- ------ -- ----- --------------------------------------------------I------------- ---------------------------------- ------------------------------------- ------------ ---------------------------------------- ----------------------- ------------------------------------ --------------- ------------------------=------- --------------------------------- - ------ 4 /----------------------------------------I-------------- --D--a--t--e-----------------------------FINAL INSPECTION BY------ --------1_ T4 SAN ----------I-------------------- ------- ---------------------------- 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'—' 2"10-52 Revised W-2100