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07 F APPLICATION,FOR SANITATION PERMIT PermitlNo.tf -------------- (Complete - ----(Complete in Duplicate) Date San Joaquin Local Health District for a permit to construct and install the work herein described. PP q . A lice ion is hereby made to the h County Ordinance No. 549.. ' � This application is made in compliance ; �- � � 1 �� p (it _. •---- - -- JOB ADDRESS AND LOCATION.____ r= - p lS C ✓ ------------------------------------ Phone ll�------------------------- Owner s Name__________ _AN �- �----� � � !�r �--- x � - �-�-'--------------------------------------------------------------- ---------- __ -- -i� Address..___..--------- " Contractor's Name------.-- ' I - Y Phoned Motel , Other C1 Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ElU ❑ Number of living units: ---`-- Number of bedrooms __Zn Number of baths ___I___ Lot size -----------.-- I.I.. ---------- Water Supply: Public system F1 Community system 11 Private Depth to Water Table � ft. n 0 Character of soil to a depth of:3 feet: Sand E] Gravel ❑ Sandy Loam Clay Loam C] Clay ❑ Ad`obe_p _.Ha a, 1 �! previous Application Made: Yes 0No New Construction: Yes El""No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �. [No septic tank or cesspool'peFr;itteit-if public sewer is available within 200 feet) Tank: from nearest well___ .-..Distance from foun ation__L ----Material---_-(�---------------- Distance -- + Septic ___Ca acit -f I/ No. of compartments_-------�' ---------Size-- Liquid day II p Y Disposal Field: Distance from nearest well_C ----Distance from foundation____l� -___-_..Distance to nearest lot lis ______..____ Number of lines.---------/---t - ---- -- .�--Length of each line-------- ,.t---.Widfih of trench_-----��-�]---------- ELKI Type of filter material!_- �_-y___-_-Depth of filter material; _ ---------------Total length_-_-I _____-,-------------------------- Seepage Pit: Distance to nearest well_:___________________Distance from foundation____..______-__-.__.Distance to nearest`rest lot line______-_ Number'of pits-------=--------------Lining material---------------------- Size: Diameter---------- - ---------..Depth--------- ------------------------ ElI Cesspool: Distance from nearest well_______.--------.Distance from foundation___________-_-___.Lining material_________________________------------ Liquid _________- Li uid Ca aci _ __________ gals. Size: Diameter--------------------------- ---------- Privy: _ q p . � _- Distance from nearest building l� - ---------------------------------- to Privy:' Distance from nearest well----- ------------------------------------------ �� ❑ Distance nearest lot line----- -------------- --- ------------------------------- -- - i i Remodeling and/or repairing (describe):------------------------------------------------- -•--••--------•---------- ---------•----------------------------__.... ----------•----------------------------------- ----- -------------------------•---------------•- I hereby certify that I have prepared this application and that the work will be done in accord_ ante with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -----------------------,----------------------(Owni[er-and/or-Contractor)—, BY:--------------------------------------------------- _------------------------------------------------------------------------ (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reveylse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________ DATE--- U y r ` DATE--------------------M-------------. --------------------- REVIEWEDBY--------------------------------- ----------- ---- -------------------------- BUILDING PERMIT ISSUED-----•--------------------------- ------------------------------------------------- DATE--------------------±- ------------------- ---------------- -------------------------------- Alterations and/or recommendations:---------------------________. � -----------------•----------- ---------------------•------------- --------------------------------- ------------------------p-------------------•••-•-------------- } -- ----------------- --------------------------------------- --------- ----- -=,i - - --------------------------------------- -------------------------- -------- ------------------------------ =1I�- �- -- f - �- ' ------------------- Date.--------------�-.�--------- - � ----------------------- -• FINAL INSPECTION BY--- -------- ----------------- ---------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West oak Street 132 Sycamore Street sit North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteea, California Y.