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APPLICATION FOR SANITATION PERMIT Permit No,a___3.-/___ (Complete in Duplicate) 1 Date Issued . /7_ -_.3_-Y Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-_ " ` '_ w` p 1Vp = " ------------------------- ----- Owner's - _-. Phone-_ "" - - '----- Address 1.7s 10_L - --------------------------------------� --- Contractor's Name__..p_z_AC'------h�---0"-__x0_ * ---------------------------------------------------------------- 'hone-f ------ - - --- Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ \� Number of living units: _1___ Number of bedrooms _9—__ Number of baths __/__- Lot size _-//.��^-.�'�__.__�"-Qn_`------------------- � Water Supply: Public system El Community system ❑ Private x Depth to Water Table `7-____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe), Hardpan ❑ Previous Application Made: Yes ❑ No W 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---N------Distance from foundation_______---------_Material___ -------- . No. of compartments--------2--------------Size--6-'-4--X---7-----------Liquid depth--- `�,. -------._Capacity--- ----------- / Di11_ Disposal Field: Distance from nearest well from foundation----/_ _r_______.Distance to nearest lot line_____if------- Number of lines-------------I-----« 5-- - ---------__Length of each line------, . !----- -Width of french-----�4-0------------------ .Type of filter material.__1__�_ At-----Depth of filter material-___ length-------a�__O_r__________________ ___ Seepage Pit: Distance to nearest well----/QO.1----Distance from foundation_____ r� __....Distance to nearest lot line__-_P_F----- Number of pits-----.�---------------Lining'material__ tF *_Size: Diameter----2V_��__--__Depth--------"O---------------` Cesspool: Distance from nearest well _--___________Distance from foundation--------------------Lining material-----------------------------------._. ❑ Size: Diameter----------------------- ------Depth----------------------------------------------------Liquid Capacity----------------------------gals . Privy: Distance from nearest well---------_-------------------------------------.-Distance from nearest building-------------------------------------- .NK❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------- - Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------------------- ` ---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed] l ------------------------ ------------------------ ( u/nar -eaA/or Contractor) n ' By:----- �.:. -------------------------------------------------------------------------(Title) --------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY -------------------------=------------------------------------------------------------- DATE_ ---------------------------------------------------- REVIEWED -_------------------------------------------------ �p APPLICATION ACCEPTED SY_f?'.- F REVIEWED BY------------------------------ - - -------------------------- ------------------------------------- ____ DATE------,.(�'t,',-'----------------------------------------------- - ---- -------------- ------------- BUILDINGPERMIT ISSUED-------- ---�---------- ------------------------------------------- DATE---------------------------------------------------------- Alferationsand/or recommendations--------------------------- ----------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------- --------------------------------------------------------------------------------------------------------- - --- - - - - -- - - - FINAL INSPECTION BY-------- - -- -- --------------------- ----------------- Date.-----------y` --------------------" - S SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manfeca, California Tracy, California ES-9-2M 8-51 Revised W-2100