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APPLICATION FOIZ�SANITATION PERMIT Permit No. (Complete ink Duplicate) Date Issued Applica#ion 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 Ordnance No, 549. JOB ADDRESS A D OC ON.... ------ ------ caner s Name------ --- ----- ----------------------- ----� �--n-------------- ----- - - ------------------------- --------------------------------------- Phone----------------------------------- Contractor's Name___ --------- -- Address----------- - ------------•-------------------------------------------------------------------------------------------------••----------•---------------------------- _ ___ Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court Phone-__---thee--___ . 77 ❑ Mosel ❑ Other ❑ Number of living units: Vc"ornmunity Iumber of bedrooms _ +� Number If baths __I-___ Lot size -- -__ Y 0 /9---------------------------- Wafer Supply: Public system system.❑ Private ❑ Depfh-fo WaferjTabler_`_---_ ft. I Character of soil to a depth of 3 feet: Sandi Gravel SandyLoam ,❑ I ❑-� Clay Loam ❑ Clay 0 Adobe JE Hardpan ❑ Previous Application Made: Yes ❑ No New Construc+ion: Yes ❑ FHA/VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: ~ . ❑ ❑ } (No septic tank or'cesspool permitted if pub�ic-sewe is available rirrthin'200,feeti) ` Septic k: Distance from nearest wellc0� ` - i`stanre from ��unfion M t I Dis os Field: Distance f pa_r„tmenis- ------ - _Siz _ I _ r ?4 Y Liqui depi h- a er -Ca aci d --- Capacity--p ty-- -- G p from nearest well- D Distance from foundation”-, �✓ � �- � �� -- F-- --.�tDistance to nearest lot linetq�-_'Y�'J• . Type of filter materiae Length of each line- F�;er � _-W�dth of trench---_---_- ' { Number of lines--------_-_ - ______ � �-�'C�epth of filter material---- Seepage length---------------1- --------- S_eepage Pit: Distance to;nearest well_:_--------______�__Dis+ance from foundation-------- ___------ to nearest lot line----------------- •�❑ Number ofpits Lining material------------- ------Size: Diameter----------------------Depth-------------------------------- Cesspool: Distance Distance fr0.om nearest well--------------- --Distance from foundation-_-_---------------Lining material--_.-_--_________- t --------- Sfze: Diameter--------------------------------------Depth------------------------------------................Liquid CapacrtY-------------- ------- ----gals. Privy: Distance from nearest well-_--_------_ --------------_--------__------Distance from nearest buildin ❑ Distance t nearest lot)line------------- ------ g ------------------------------- ------------------ Remodeling and/or repairing (describe)------------------------- -------------------------------- -------------------------------- - ----------------------------- •--------------------- ---- •------------------------ ------------•------- ------ ---=---- --- - hereby ti -- - - - --- e - is - •- --- ----•------------------------------------------------------ ! 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. 1 (Signed) Plot Ian ---- ------- ------Z-- --- - --- --- ----------- -------------------- -- By:•--•--------------•----•-----------.--------------------------------------------------------- --•-- I - (Owner and/or Contractor -------------------------------------------------'-------- --- -------" -- - - -------- ------(Title)------------- ------------------- - -- - ( plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y _ DATE f REVIEWED BY ----------------------------------------------------------------------------- -------- --------- ---------------------------- -- ----- DATE- ILDING PERMIT ISSUED----------- J----------------------------------------------------•------------------------------ DATE- Alterations and/or recommendations: -------- --------------------------------- ------ --------------------------------------- /------------------------ ----------- ------------------------------------------------------ --------------------------- ----------------------------- ----------------------------------- - ----------------------------------------------------- FINAL INSPECTI Y:_ Date- S -----------------------------------•----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi, California 814 North "C" Street Manteca, California Tracy, California ES-4--2M , Revised 1-57 F.P.CO-