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� qG� qq ' APPLICATION FOR SANITATION PERMIT Permit No. ..__.(_____f___ _ (Complete in Duplicate G ] Date Issued---._--- Application is hereby made to the San Joaquin Local Health District fora permit to constru t and ns all the work he ein described. This applicaafion is made in compliance with CountyOrdinanceNo. 549. . 7'- rzz- JOS ADDRESS AND LOCATION___ __- 0 ------- Owner's Names l ----------------------•--------------------------------------------------- - Phone Address---------------- - '' ` ---------- Contractor's Name----- -----=----------•-.........................--------------------------------------------••----------------------- Phon.e.---------------------------------- Installation will serve: .Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [ Number of living units::/ umber. of bedrooms Number of baths /___. Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Wafer Table _______ ft, x. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam [❑ Clay Loam E] Clay D. Adobe Hardpan F1 Previous Application Made: Yes E] No New Construction: Yes=e,�o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspoolyerrWf6d if public sewer is available within 200 feet.) Sep is Tank: Distance from nearest we41_ ��---Dista co ro founclation_________________ Mfe :_No. o�compartments____. --________ __, iquid depth___ _.___ Capacity_.. . _--; _ Dis oral Field: Distance from nearest weli.1 .._.Distance from foundati nrDistance to neat lqt I' eZ,,� Number of lines______- �`"" Length of each line_____ `_ W,dth of trench._ _ "_-----'________. -� Type of filter ma`ferial/"_V* epfh of filter materia--------- l�lf...Total length-------- -----------f_________________ Seepage Pit: Distance to nearest well____._.___--------Distance from.,.foundation____----______-__.Distance to nearest.lot line__ __________ El Number of pits----- - --------------Lining material---------------------.-Size: Diameter.---------._-------------Depth----------------------------i, Cesspool: Distance 'ficm nearest well_;--------`......'Distance from foundation____________________Lining material--------------------____.________ ` ❑ Size: Diamefer-------I------------------------------Depth--------------------- --------------------------:._Liquid Capacity----------------------------gals. _ ' R Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------.------------------------------- b ❑ Distance to nearest lot'line --------=----------------------------------------------------------------=------------------------------------------- � Remodeling and/or repairing {describe]-------------------------------------------------------------------- ------- ----------•--=-------------------•-------•-----------------------------------------•-----------------------------------•--------------------------- --- ---- -- -----------•---- - ---- ---- - ---- --------------------------------------------------- �1 -----------------------------•--------------------------=------,---------------------------------•-----------•----------------------••--------------------------------------•----------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ina ces, State Igw�..•and rules and ie,uldtions of the San Joaquin Local Health District. ordinances, g - ' -: �(�,,. _ ------------------ (Owner and/or Contractor) By=---------------------------------- -•-•-•----------- ------ ----------------------- ----------------------------------------(Title)---------------------------•-------------=---------------------- (Piot plan, showing size of lot, location of system in.relation to wells, buildings, etc.,.can be placed on reverse side). FOR DEPARTMENT USE ONLY Y APPLICATION ACCEPTED BY------------------- ----- ---- ------------------••----------- DATE---------------------- - - -------------------- IEWEDBY -------- ---------------------------------------------- DATE-- - ----------•---- s�� t U LDING PERMIT ISSUED------------------------ - - - DATE--.--.. BUI Alfrations and/or re commendations:------ _---•---------------------------------------------------1-------------------------------------- ------------- ---- ---•------ --------------------______________________E___._..._________________________-___-_______-_.___._______._....-.--__ _ ----------------------------- -------------- --------------------------- _________________________________ __ ._____________---------------__-----_ ____.________.______._________ --------------------------- 7-�-7- FINAL INSPECTION BY:------ .. Date ----------------------------------------------------------------------- 0 SAN JOAQUIN L CAI. HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1.57 F.P.CO.