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''' ppp PLICATION FOR SANITATION PERMIT P it I�o.J11�-�--- S� (Complete in Duplicated /� 3 -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 with County Ordinance No. 549. !10-77 z s - X4c_r_ )Z-a y le J ' Q' JOB ADDRESS AND LOCATION_.._..- -�'-- r ---- �"' ________________________ Owner's Name----------_------ ...... .--'-..Geapge--------- ----------------------------------------- Phone----- Address Q-t ..�-.... ?!-!✓` .._ ._._- '1J ��- --- - ---- -t-s --• ---------------------------------------------------- Contractor's Name--------------------------------- - C� GI J ' ''� ./ ----------- Phone---- _`�-__7---------- Installation will serve: Residence Lam, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ J. Number of living units: __. Number of bedrooms 3____ Number of baths _1 Lot size J __-7_4------------------------------ Water Supply: Public systerrCommunity system ❑ Private^-2' Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam 0 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑�.... �' a e, ti TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan istance from nearest well-----------------Distance from foundation--------------------Material-________________________________________-_-____- Ft o. of compartments----------------- -------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well//O---------- .Distance from foundation__w_l--------Distance to nearest lot Number of lines__J______________ ____ Length of each line-----7_4-----------------Width of trench__V__4--_f_________________-_ Type of filter materiaL._l_--�� __Depth of filter material____ -------Tota; length-------f'c�_'______ Seepage Pit: Distance to nearest well---------------.—Distance from foundation--------------------Distance to nearest lot line__-_______._____- y ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- J rCesspool: Distance from nearest well_________________Distance from foundation----.---------------.Lining material____________:________________________- N ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. P.riy Distance from nearest well__________________________„________—___ Distance:from_nearest.buildi.na._______.______.____•_ Y . _ . T� - ❑ Distance to nearest lot line-----------------------------------------------------------------------------------------------------------------------------•----------- 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 laws, an les and regulations of a an Joa uin Local Health District. f, /� (Signed- `-a f- -rzr"Q r c� ��s r Contractor By:------ -------- ---------------------------------------------------------------(Title -------- --- (Plot plan, sho 'ng size of lot, locatio of system in relation to wells, buildings, etc., can be pl ced on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -- ------------------------- DATE-------------- ----t,(� REVIEWED BY-------------------- - DATE--------- r ` t 5�-�-----:-------- BUILDING PERMIT ISSUED-----------------------------V---------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------- ----------- --------- -------- ------------------------------------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------- ------------- ----------- ----------------------------------- ---------- ----------------------------------------------------------------------------------------------- FINAL INSPECTION BY:---------- -------------------- ----- Date---------- ------ g� --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North '-'C” Street Stock+on, California - Lodi, California Man+eca, California Tracy, California 8 ES----9---2M 8-51 Revised W-2100