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APPLICATION FOR SANITATION PERMIT Permit • (Complete in Duplicate) 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. l JOB ADDRESS AND LOCATION-__,,_4___7:!y------1 -ciX----A t ------- .T��)t__.�-------0F ?n' {, c -_ Owners Name Phone------ . Address------------------------------- Jss�-' = ----------------------------------•--------------•------------- ---------------------------------•---------------------------------- Contractor's Name--------------- l/r�Y1:.-.I�.�J I ------------------- ----------- ------ Phone-------- ------------ R Installation will serve: Residence El''Apartment House E] Comm`ercial [-ITrailer: Court ❑ Mofel ❑ Other ❑ Number of living units: !_ Number of bedrooms --/-- Number o£ baths __r____ Lot size _)__.Y--_7_ _____________________ Water Supply: Public system ❑ Community system ❑ Private E-16epth to Water Table�f _'ft. Character of soil to a depth of 3 feet: 7.Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: YesNo ❑ New Construction: Yes�No ❑ 1 HA/VA: Yes ❑ No ©� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) r f,� Septic^Tank Distance from nearest well_/ ___ __Distance from foundation__._.__ _ ��--- -----.Material-- 4-'�1't-��--�------------- ------- P . �i�C No. of compartments Size l Liq id depth---------— ----_--'Capacity--- �� Disposal Field: Distance from nearest well�1, -----__-Distance From foundation___________J Z.Distance to nearest lot line___-.�'�..___ ❑� Number of lines----l-------------- - ------------Length of each line--------------._--- Width of trench-------•----I -------- Type of filter materiaf_-----1 F.4 �_------Depth of filter material---- ------------Total length--------- - ------------------------ �w '. Seep�a,gee Pit: Distance to nearest well---jA,Z!_r--------Distance from foundation___-/-0-. .....Distance to nearest loft line__--_��~---____ J Number of pits---Z---------_------Lining material____VVA ____._.Size: Diameter__.1i_--_____._--_Degth____J, Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El ___----________-______._---______ . ❑ Size: Diameter-------------------------------------Depth--------------------------------------- - - - - ------ Liquid CapacitY---------------------------gals. Privy: Distance from nearest well---------------------------------------------...-Distance from nearest building ❑ Distance to nearest lot line------------------ ----------------------------------------------------------------------------------- 1 Remodeling and/or repairing [describe]________ ________ ---------------------•------------------ •------------------------------------------------------------------------------------------- ------------------------------------ I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, Sfaf laws,,and rules,:and regplations. f the San Joaquin Local Health District. (Signed),5 r f � r, i (Owner / Contractor) ---------- --------------------------------------------- ------ -------------- O and or - ---------------------------- By:----------------------------------------------------- ---------- ------- - -- Title _ (Plot plan, showing size of lot, location of system in.relafion to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --------'---------- ---------------------- -- ------------------ DATE------ �� --- ------------------------ ---------------------------------------------------------------------------------------------- ---------------------- IEWED BY ------------ ---- -- - ----- DATE BUILDING PERMIT ISSUED--_----------_------- ----------------------------------------------------------------- ---------- DATE Alterations and/or recommendations:-------------------- -•------------------------------ ----------------------- - ------------------- FINAL INSPECTION BY:.___ ---- _�_, Date__.. ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT M South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---4-2M . Revised 1-57 F.P.CO. a