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APPLICATION FOR SANITATION PERMIT Permit No. ___-- _ 7 {Complete in Duplicate( ! Date Issued ___.- f/�3�� G • A I' t' h 1 I Pp ica on is ereby 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, JOB ADDRESS AND LOCA ION_-_�-i_y� 09 )- 7 ii 7e i�^ II 7" "" Address �_------------------------------------------------- --•-------------------------- ---------- Owner's Name---a-----�,.----- -�'- �-�---------- - - --- --------------------------------------------------- -. Phone-------------------- i----------- II--------------------•-----------------------•------------------------------- ---- ------------•----------------------- Contractor's Name ----- I/j't$' I -— T°r _ t�.�' Q- ------------------------------------------ Phone.-- y�4 _,J_74_ Installation will serve: Reside lllce ,IR Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _t_-- Number of bedrooms 2&--- Number of baths _�� Lot size /q'e---_-"-_----" ---------------------- Water Supply: Public system ElCommunity system ElPrivate ® Depth to Water Table KGs_ ft. Character of soil to a depth off 3 feet: Sand ❑ Gravel ❑ Sandy Loam III! _]Clay Loam EDClay ❑ Adobe.® Hardpan F] Previous Application Made: Yes ❑ No [4 New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION A! D SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance f�h m nearest well-_______________ Distance from foundation -------------------- Material----- ------------ ---•-----•-- -- ❑ No. of compartments___ Size Disposal Field El Seepage Pit: 19 Cesspool, ❑ Privy•. Distance Number Type of Distance Number Distance i Size: Diann Distance f Distance ti I---------------------- I -------------------------------- Liquid depth -------------------------- Capacity )m nearest well_______________ _ Distance from foundation ---------- ---------- Distance to nearest lot line______________._. lines-------------- -------------------- Length of each line ------------------------------Width of trench ------------- 3r material------------------------- Depth of filter material ----------------------- Total leng+h---. ------------- nearest well-_.f_+t;► 7_` --_-_Distance from foundation --/P. ___.___.Distance to nearest lot line --10--4 pifs-_-1 -------------- Lining material____'kk_G.# -----Size: Diameter__ 3 f_ 4-_ Depth------------�-------- 7m nearest well________________ Distance from foundation-------------------- Lining material--________--_--.___________ -_ ter------------------------- ----------- Depth --------------------------------------- -- --------Liquid Capacity --- ----------- m near`es't well --------------- ____________-- ---------------------------------Distance from nearest building 9 nearest lot:I ne______________<.______ --_ Remodeling and/or repairing('describe):-------- _______._____-._____ _ --------------- ------------------------------------------------ I �I 7; ------•-"=------------- - -- ------------------------------------------------------------- --- -------------- ----------------- ---------------------------------------•----------0------------------------••-------------------------------------------------------------------------------- ------------------------------------------------------------- I 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. n A (Signed)---------------- ------ B• (Plot plan, showing size of lot, T __.___--(Owner and/or Contractor) ----------------------------------------------- --------------------- ----------------------- (Title)-------------- :ation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY��I •-------------- -- •------------ - - - -- ---- -'------------ - ------------------------------------- DATE---- -----------•-------------- -- ---- ----- --- - REVIEWED BY ---� ----------- ---- - --------------------------------------------------------------- DATE ----------- BUILDING � - BUILDING PERMIT ISSUED______:)______._____________ 1?� - ------------ 4r-- ------------------ - -------------------------------------------- DATE Alterations and/or recommendaifions: --- ----------- ------------------------------------------------------ ___________ _�- `�---- I--i- ---------- -------- ----------------------------------------------------- - ,,v ------------ ----------------------------------------------- -- -------------------------------------- ------------------------------ --------------------- •------ - -- ---------------- J11= ----------------------------------- ----------------------------- ; FINAL INSPECTION BY: --------II Yl Date------- ---1- / --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I I Lodi, California Manteca, California Tracy, California ES ---9-2M , Revisea 1.57 F.P