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G lry1 re�-Z, �D Permit No. ._ (f_ APPLICATION FOR SANITATION PERMIT / t i (Complete n Duplicate).. Date issued _____ Applicafiion 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 Ord Hance No. 549. , I __ __ ________ _________.._ ______.__ __..__---__..___________------------------------------------------ eJOB 4. -4 D LO ATION_'__! i----- -- ;-11-- ------------------- --- Owner's Name------ ------ - ------ ------.:--- ----- ---------------•------- ':---------------------- - ------------- „ , _ , , Phone i .. . .1 t � -------- ---- A ContractoPs Name---- ------g ------- --- ----�-�-=-- --------t-� -cS . :. ai r9--------------- * :. Phone Installation will serve: " Residence [[rr Apartment House ❑ Commercial ❑ Trailer=Court ❑ Mgtel ❑ Oth�r ❑ Number of;living units: __(___ umber of bedrooms ____ _-. Number of'baths __.____-Lot size-._._ __------ ---_ _______cj5_----------------.----------- Y Wafer 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 ❑ Adobe Hardpan ❑ Previous Application Made:` Yes ❑ No� New Construction: Yes [�o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION SAND SPECIFICATIONS: (No.sepfic tank o'r'cesspool permitted"f ubiic se er is available within 200 feet) Disfan fro fou tion 1 _- --Ma e ial__ �60pa,5y!_ _____.-_-I-- Septic ank: Distance from nearest wel ''V /�! (/.-----_-- j s No. of compartments-_-_-_- -------.--- Size_ --1_--------___::...:Liquid+depth_'-- ------------ :._-L7- r Dis os Field: = - Distance from_ nearest welly"--_ Distance from foundation�ll:_- __ Distance to nearest lot n r p t Yr Number of lines____'_____ ___:._-- _____ 4 Length of.each,line----------- -Width of-trench.__________--__ Type of filter materi ' __ epth'of filter rrsaterial__________ _i.7-- pit: Total length------------------__/. 0___ � �p�, D.. Seepa e -Distance to nearest wt�eell________________ __Distant rom f 'ndation___ _______.._____. istancetrto nearest lot line -''Number of pits--------- ---------Lining maferial_ ..��ize: Diameter____-[a�-�------.Depth........?t- ---_-.------ Cesspool: 1'6stance from nearest well-------------_---Distance from foundation--------------------Lining materia)-----------------------------L .� El Diameter.~ =_ --------'--Depth--------------- ------------- =--- "---Liquid Capacity gals. ( Privy: Distance from nearest well—-.-------- -------_---------- ---------Distance from _......nearest building----.,----------------•----_---------- ❑ •-Distance-to nearest lot line.----------------- ---..--- - -- -_-------------------------------- - ---------------------------------- Remodeling --- -- ----------- 1 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� ordihancesr State aws and rules and regulations of the San Joaquin Local Health District. a t f �_________________ Owner and/or Contract t (Signed)---- ----- --- -----•----'"`�--_�'w-��--��-`-��-------_--------_ ------ -----------;------------- ------€--------------- ----{ � �._ �� k •` ---•-•` _ g ----(Title)-----------••-------------------=-�--- -" --------- h Y' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side. 6 � a FOR'DEPARTMENT USE ONLY ---- DATE_, ------------------------------------------------ APPLiCA7ION ACCEPTED BY ---- -- --------------------------�------------------ --------------------•-;----- � - -- ---------------------------------------------------- lE REVIEWED BY----------------------------- ----- - --------------------- ----_--- ------ -- --------- DATE BUILDING PERMIT ISSUED----------- ---------------------------------------'- - _ DATE. -""'�'--------- r Alterations and/or recommend ations:____X _r___.. '�---[ 1+!�__ t�- ---- • -- Z I-- � ------"•-- _ �- r . . --------------------------- ---------------- --------------------- --------------------- ------ - -- ------ r` � x-1� ^'`} - - YJ -- -------- . FINAL INSPECTION BY - --- - - '- ,..�'-_:�.. � -Date_ -�-=�'-/��-=--�-�- . " SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Maatece,..Californie Tracy, California ES-9-2M , Revise6 "57 F.P.CO.