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/`,q R /'/7 -)-- APPLICATION -APPLICATION FOR SANITATION PERMIT Permit No. L (Complete in Duplicate) j� Date Issued ___-l_��5`r Applicaa-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. s JOB ADDRESS AND L TION__ �l-- ------ -- ---•---- -- •�y-F a Owner's Name. --------------------- - --------------- Phone l Address--------------------_--�--1�2..�---------�-.0 '' ... - -----------------------••------------------ Contractor's Name '-c�}�"'-`------ ------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E❑ Other ❑ Number of living units: __.(___ Number of bedrooms _'?Number of baths _-#*/ Lot size __--- _. - „ ---r-_ -a _ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Tabled'- ft. v. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay L m ❑ Clay E❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 91-`New Construction: Yes ❑ No ❑ _ ° TYPE INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.] F eptic Tank- Distance from nearest well------------- ___Distance from foundation------------_------Material------------------.--------------------- L_:_-.. No. of compartments- ------ --.-Size_-----------------------------Liquid depth--------------------------Capacity------------------- sal Fi Distance from nearest we31.................Distance from foundation--------------------Distance to nearest lot line--- -------------- Number ____-_._____...Number of lines------------_---------------------Length of each line----------.------------------.Width of french----------------------------------- Type of filter material------ _. -------_-------Depth of filter material--------.-------------- otal length_________ ______.___._-______________- Seepage P Distance to nearest well_. ._ _dkx�-.-_-_Distance fro ou dation__] _...-.___ istance to nearest lot line-------_s�__----- Number of pits------- ------------Lining material- _Size: Diameter_ - `'.__--____Depth_r�_ _ ____ _______ Cesspool: Distance from nea�resf well---_-------------Distance from foundation______________ Lining material -________.--------------------------- El _;_---_._______-- _____.❑ Si2e: Diameter------------------------------------- Depth------'--------------•--------------------- --------Liquid Capacity------- -------gals. Privy: Distance from nearest well----:---------------------------------_-----------Distance from nearest building.- --------------------------- ------ ❑ Distance to nearest lot 1i_ne---------------------- ------•---'--------------•----------------•--•----------------- ------- - --------------- Remodeling and/or repairing (describe):----- ,- --------- ---------------'-=------------•-------------------------•---------------- ------------------••---- f ------------------------• ------------------------------------- ! ------------------------ ' ----------------------------------------------------------••-----•------------ ..---•--.......-----------------------------------------------•----' --------•--------•------•----------------------------------------- ! ere;YL-lafe"Ifayws, that I have pre ed this application and that the work will be done-in`accordance with San Joaquin County ordinanc sand rules and gulations of the San Joaquin Local Health District. (Signed)--- - -- -- ---------------- - ---- Contractor) By:----------------t...'...................1------------------------------- - ------ - - ------ ---- (Plot -(Plot plan, showing'size`-of lot, [ocation of system in a tion to Wells, 6uildmgs c., can be paced on reverse side]. F �� FOR DEPARTMENT USE ONLY c APPLICATION ACCEPTED BY RATE C} � ' ------------ REVIEWEDBY -- ---------------- ------------------------------ •-------- DACE -�------------------------------------- BUILDING PERMIT ISSUED------------------------------- -7�1----------_---- ---------_-------------- ------------- DATE- Alterations ATE Alterations and/or recommendations:----------- ............. ---\ -------------------------------------------------------------------------------- ---------- -•-----b------------------ ------------------------------------------------------------------------------------------- ------ -----------------•----------------------------------------------------------- ----•--- ------- ---`-----._...---- ----• •---- •-------------------------------------- -------------------------- -------------------------- -'- ---------------------------------------------I----------------------------------------------I ------ --- ----- ------ �6�� r FINAL INSPECTION BY: .. r --- ---- -- Date.-----� -~•-�--------------- -------------- -------------•--•---• �' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21A T45446 ATWOOO 12-54 JI