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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 7 Date Issued _ -Application is hereby made to the San Joaquin Local Health District for aVpermit to construct and install the work herein described. :,,This application is made in compliance. County Ordinance No. 549. -- - JOB ADDRESS AND LOCA�►lON_ __ - - - '� o cam'fry L" f7� > �y -- ----- Phone-----.---- Owner's Name = -�---•------ { ' 1 -------------------------------------------------------- Address . � ------•--------------------------•---------•-------------------------------------- Contractor's Narne -------------------------------------- Phone Installation will serve: Residence ` Apartment HouseCommercial ❑ Trailer Court E] Motel 0 Other ❑ rr Number of living units: __� ___ mber of bedroom _ ____ Number of baths ___/___ Lot size _____________/f_ _ C• f Water Supply: Public'system'❑ Community system WPrivate ❑ Depth to Water Table ---------ft. Character of soil to a depth of 3 feet: ; Sand ❑ Gravel ❑ Sandy Loam� Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ Nox New Construction: Yes, No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank•or`cesspool permitted if public sewer is available within 200 feet.) s�/ - Septi Tank: Distance from nearest well__ ____Distance e from fou tion__._-_.____Mater al _ : _ Na.,of compartments :---------Size___ 77C�C-------=-•-Liquid depth -Capacity Disposal Field: Distance from nearest we -- ---Distance from foundation__ ____ f- �/ __._.Distance to nearest lot line_i__��._______. Number of lines_. ______Length of each line______________ Z g TC-i------- Width bf trench T �e of filter material____ _ / YP -----..-- epth of filter material____.___________-_Total length--------,l _--- ,{�-- See age Pit: Distance to nearest well.__' -----Distance from n aon_3�4._ _ tante to nearest loft line___ _-.-. I Number of pits----- Lining material `- ize: Diamefer.,,e ___--. Depth ; r Cesspool- Distance from nearest well-----------------Distance from foundation______-_--____.___.Lining material_________-.____________-__--______--. ❑ Size: Diameter------------------------- ------------Depth---------------------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------___________________________________.x_._Distance from nearest building ❑ Distance-to nearest lot line-"=-------------------- ----------------------------------------------------------------------------i Remodeling and/or repairing (describe)_---------------------------- -•-------------------- -----------=----------- -- r ------•----------------- -----------------•-------------- -----••-•-----------------------------•-------------------------•-------------------------•---------•---------------------•--------------------------------------- --------- I hereby certify that I have prepared this application and thaf the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and regulations of the San Joaquin Local Health District. (Signed)_ / u ------------------ ----- ---------------(Owner and/or Contractor) ------------------------------------ BY� ------------------------------- ------------------- `------------------------------------------------- Title I (Plot 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 BY - -------------- DATE REVIEWED BY----------------------------------------- ---------- DATE------ -•- =-- - -- --- ----------------------------------------------------------- . --- BUILDING PERMIT ISSUED----------------- - ------------=------------------------------------------------------------------ DATE---------•---- - Aterations and/or recommendations:----------------------------------------------- ------------------------------I------- -------------------- -----------------------------------------------------------j----------------- ---------------------------------------------------------- ----------------------------I------------------------ --------------------------------------------- 44 FINAL INSPECTION BY----- --------------- :�-' _�_-=:-:-'-"",.' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American SfFeet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9--2M , Revises 1'-57 F.P,CO.