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APPLICATION FOR SANITATION PERMIT Permit No. !-___ (Complete in Duplicate) 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 withLouinly Ordinance No 549. Z 1 ( SZt1 ^0 060-- u -------•---------------- JOB ADDRESS ANID LOCAT ON__ !_.P,_ .Q_�.._ .-----•------------- ,/ ----------•---------- _Phone ---•-•-•-----•••---•-------=-•---_.. Owner's Name.-•-- .-1d1.:!_�.cE='�'';RS=• e Ad ..................................................... -------------------------------------•------------------ Contractor's Name ....... %l" -•--•------•-•-•-•-•---- --------------- ___ ....... -•_-------------- ---•-----......... -------•- Phone -----•---___--•--•-- ---------- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _._V—_ Number of; bed rooms:'•: s u _mber-of baths _____... Lot size __ 5. Water Supply: Public system ❑ Community system ❑ Private [q�" Depth to Water Table j_Vft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe' Hardpan ❑ e Previous Application Made: Yes E]No f 7r New Construction: Yes [ No .❑ TYPE OF INSTALLATION AND. SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_._.�_Distance from foundation____J.O_____.Mat�_�� 1 No. of compartments --------------- Size ----- _ .__ __ Liquid de th_-_.___ S"._ ---------- Capacity.--,,--� ----------- Disposal ---___ _Disposal Field Distance'from nearest well_._'T_,[r___-Distance from foundation._. -0 ........ Distance to nearest lot line Number of lines_-_______ en th of each line.1_(,? 04.*J_5_.Wic1th of trench --,A.________________________ • g Type of filter material_-ST—I. tZ epth of filter material ... I$ ...... _..... Total length ------- /L.9_19 _____________--..___ Seepage Pit: Distance to nearest well ...................... Distance from foundation .................... Distance to nearest lot line .... _____________ ❑ Number of pits____.. --------------- Lining material --------- •............ Size: Diameter ........ .............. Depth .-__----_------_-__-____----...... I Cesspool: Distance from nearest well. ________________Distance from foundation .................... Lining material ................. _.............. . 1 ❑ Size: Diameter....-------------- ----------- ••Depth,_-- ......... ...................................... Liquid Capacity_ ......... ................ gals, Privy: Distance from nearest well ---- ------------- _......................... distance Tr6mlegrg ......... ........... ............... ❑ Distance o nearest lot line.................... -•-•-••• r s--- ---- j _ - --•-------••--.. ----- -----1 . 4o ML. Remodeling and/or reliring� describe):----- --• �------------- • -- •--- --• - 2-tZ r=, APv�_ ....fir..., .�.�o/ ,...� 2.-/ 4 53 ,(Zda � �• -----------•-------------------•-----•---------------•------------------ =--_-----------_--_ .............. ------------------------------------------------------------------------------------------ --•--- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulesand regulations of the San Joaquin Local Health: District. Owner and/or Contractor 1�'_--.__-_---•--------•------------------------ { ) ' BYE----------------------------- -................... �..----•------•------------------------.....---------......................... (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 APPLICATIONACCEPTED BY..---... ...................... I------------•----------•-----•--•---•-•---------•---••---•--•• DATE---------- - -----------•-------------------------------- REVIEWED DATE-------- -:-;4.W a --•------------ BUILDING PERMIT ISSUED---- _ ...... ............... ...............-- DATE ..... ............................ Alterations and/or recommendations -_1 ........................................... -----•--------------•----- ------------------------------------ -... _.......................... .......... ..... _......... -..................................................... ............. ,_ t_....._.... --I---•----......••---•-•-•-------------•-••-•-• c m ---•-- - --- - ---------•••-•--•-------•------•------••••--•--•---------------------••-----•-----••----•--------•-----_----- .00 FINAL INSPECTION BY: ................................. Date ...........r+�-_,!_.____••-••-•• -••--• ..................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M 8-$1 Revised W-2100