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FOR SANITATION PERMIT Permit No. APPLICATION .I. U__.Q.. �� 1 �' (Complete in Duplicate) Date Issued 0plicationApis 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 N . 549. 11 -----•---- JOB ADDRESS AND LOC�}}�1 _ 6�=---------- Owner's Name --- ------------------------ t--- ------------------------- Phone_ Address ----------------------- ---------------s_ Contractor's Name ---------------------- -- - --�`-------- � Phone.. Installation will serve: Residence - Apartment House ❑ Commercial 'Ej Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----f__ Number of bedrooms /Number of bath/_______ Lot size ___ .__4-7 ------------------ Water Supply: Publics stem Community system ❑ Private Depth to Water Table .�ft. PP Y� Y ❑ Y Y ❑ p , Character of soil to a depth of 3 feet: Sand Gravel El Sandy Loam ❑ lay Loam E] Clay E]AdobeZ,,Wardpan F] l Previous Application Made: Yes ❑ No New Construction: Yes Jo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well _//)*$.td__ Distance from foundation --- 140 ----------- Material____:._----. --Liquid thNo. of compartments----_---- ----------- Size---� ------- --------Capaciy------ Disposal eld: Distance from nearest well:__ Distance from founda ion__ --- lines ------------- of trench. ------------------------ Type of filter material__r'_O c �-_---_Depth of filter materia l___._,--_----- Tota) length_____________________________ 011 See a e Et: Distance to neares well_..-�Di nce._fro un a i n / d Distance to nearest I ------------ p g Number of pits...W ell - m erial___YG +I e: Diameter__` ` Depth Cesspool: Distance from nearest well ____-___._______Dis o,ndation------------------- _Lining material _______..__------_._______________. ❑ Size: Diameter---- -------------------- ------ Depth ----------------------------------------------------- Liquid Capacity - --------------------------gals. Privy: Distance from nearest well ------------------------------------------------- from nearest building ---------- __---_________________________- ❑ Distance to nearest lot line --------------------------------------------------------- ----------------•-------------------------------------- ------------------------ ---------- ----------------------- Remodel' _and repairin (de cribe): - ----------- �---- ---- � `'-------- ------------------------------------------------------------------- ----------------------------------- ------------------------------------- �7 --------------------------------- ------------------------------------ --------------------------------•------------------------------------------------•--------•--------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this p lieafion--and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules3,an� regulatiorq -gf the San Joaquin Local Health District. (Signed)--------•------------ 4,a -�`'- ---- ne Contractor) --- ---- ------------ -- ------------- (Ow r and/or BY:------•----•-------- ------- -- ----- - --(Title)------� ? ----------- Plot Ian, showing size of ton o sysfem in .relation to wells, buildings, a ., can be placed on reverse side). ( P g FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------- ---------- -- ---- - ------------- ------------------------------------------- DATE------- - -------------- --------------- REVIEWEDBY --------------------------------------------- DATE----------- -------- --`- BUILDINGPERMIT ISSUED ----------------------------- - ----------------------------------------------------------------- DATE ----------------------------------------------------- ------- Alterafiand/or rec mendations-------- ------------------------------------------------------------------------------------------------------------•------------------------------------------ -------- ------------ e---------------------------------------------------------------- =-------------------------------- ------------------------------ -------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------- I ------------------------------------------------ ----------------------------------------- FINALINSPECTION BY-----------------/--1�-- -------------------- Date---------------- �--- . i ------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stree+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California E5 -4-2M , Revises 1.57 F.P,CO.