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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) <br /> Data Issued .---------G-_-_____-� <br /> Applica;ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOCATION- /'- lT 7 C 1 JT O f-C-r C P /r"Y✓"�'1�•.�/G��s� <br /> Owner's NameLr[)Pte --- ---------±-------!;-ee---------- --------------------------------------------- Phone <br /> "0- 96-----o `-�3 . F9� � ✓� <br /> ..�• :----------- -------- � .. ._f-------------------- -------- ------•------------- <br /> Address <br /> Contractor's Name___��. -/-.S,s' -•, ,�_/�C. <br /> Installation will serve: Residence (`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: __/__ Number of bedrooms ---:Zn--Number of baths ___1__ Lot size <br /> Water Supply: Public system '❑ Community system ❑ Private (D--Depth to Water Table -& ft- <br /> ' <br /> Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [:] Clay Loam ElClay ❑ Adobe❑ E]Hardpan <br /> Previous Application Made: Yes ❑ No [f- New Construction: Yes ❑ No [�- <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well._------------------Distance from foundation--------------------Material <br /> ______________-______--.___________--_______ <br /> ❑ i y}i h� No. of compartments----------- ------------Size--------------------------------Liquid depth--------- - -.Capacify­---­­ <br /> Disposal Field- Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----._._____-- <br /> ❑ .rr slr 'J Number of lines---------------w--- ---------------Length of each line---------- Width of trench <br /> Type of filter material-------------- ----------Depth of filter material----------------------- length___---______________--._____ <br /> Seepage Pit: Distance to nearest well-149V..------Distance Ir m foundation_.-._.4-0..._. Distance to nearest lot line- _/4_f <br /> Number of pits.._ --____. r .__ <br /> ___ « ---- Diameter --_- Depth_._-_mss`-- ______________ <br /> Cesspool: <br /> Distance from nearest well-----------______Distance from foundation------------------- material___-__---_-__._____.__-- <br /> ❑ Size: Diameter - Depth ------------------------------Liquid Capacity---------------------------gals. <br /> Privy: Distance from nearest well------------------ -------____.___Distance from nearest building <br /> ----------- <br /> El <br /> Distance to nearest lot line________._-_________ <br /> Remodeling and/or repairing (describe): --------------- ----•� f -----------------••-------------- <br /> ---------------------------------------------------------------------------------------------------------------•--•----------••------------------•---•---------------••-----•--••--••--------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, Sf�laws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed)------ <br /> -- --------------------- --- ----------------- (Owner and/or Contractor) <br /> ----( <br /> ----- ---------- <br /> ----------------------------------- <br /> By:.... ----------------------•--------- (Title)------ <br /> ------------------- <br /> (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---------------------- .---------------- --------- •-••---------•-----•---- DATE--REVIEWED BY DATE---- --- ---� . <br /> BUILDING PERMIT ISSUED---------------------------- -_ <br /> '. ---------••----------------•-- <br /> - ._.------�----------------------------------------------------------- DATE--- ------ ------ <br /> Alterations and/or recommendations-------------------- ------------ - <br /> --------•------------- ----- - - --- --- ----- ------------ <br /> ------ --------------------------------- <br /> ----- <br /> -----•----------------- --------•------- ---------------------------- -------------------- --------------- <br /> • - <br /> FINAL INSPECTION BY:.._. 5,-------_--_ 7— <br /> ----------•---------------- Date--- -- --------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Streef 814 North "C" Street <br /> Stockton, California ' Lodi, California Manteca, California Tracy, California <br /> ES---9-2M 14s446 Arwood 12's4 <br />