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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ____ __ __ ___ ____ Application is hereby made' to the San Joaquin Local Health District for permit to construct'and install the work herein'described. This application is madeincomp lance with County Ordinance No. 549.; N _.; ) ii r„ U - .. , JOB ADDRESS AND tb ------ _---_----- 5 Owner's Name----y - -- ---- - -= ---� -',---- -•R-- --------------------- -r----- - ..Phone." ;:. -----------------=----...---- Address-------- -----G--`I--- ------ ^� ---- -------- T F -------------------------------------- Contractor's •------------- •-----.--Contractor's Name_ _5 ..__.-- _---- ---------------------,------------.. V Installation will serve: Residence [M . Apartmeht }-louse ❑ Commercial'Ll Trailer Court ❑ Motef E] Other E] Number of living units: _�__-r Number of bedrooms ___ Number of baths -______ Lot size ____ _. =---------- Water Supply: 'Public'system Community"system ❑- Private ❑ Depth to Water Table"kD-`ft.- Character of soil toa depth of 3-feet:( Sand E] , Gravel ❑ Sandy Loam �' Clay Loam ❑; Clay E] Adobe E3 Hardpan E]Previous Application Mede: Yes ] No ❑ New Construction: Yes [K No ❑ FHA/VA: Yes ❑ o ❑ ? TYPE OF INSTALLATION AND SPECIFICATIONS: , v _ a (No septic tank or cesspool permitted if'public sewer is available within 200 feet.) - , _ r .,�nr.,. .,.�.. —„..,.. ..�..•.. ry ----------y-.Material Se Ta Distance from nearest.well7Lr�•�'______Distance from=.foundation___, -- ;- ----- f .;_ No..of.compartments--------- ------- -----Size----------:--- - _--_--- depth------------ C6 pacify --------- ------- Dis osal Field: F Distance-from nearest well_ c____Distance from foundation__________________Distance to nearest lat line_____________. .. {...,, .f.Number.of lines----- --------- Length of each.line------/-�-0--------____-.Width.oftrench_�-�-------------------____-- Type of filter material_�y __Depth of filter material____!f'_'______._Total length_'___. ______ � Seepae Pit: Distance to nearest well Distance from foundation_- ---Distance to nearest lot line----------------- 9 ❑ Number of pits-- F ' - g E ; p i -------- -Linin material-----------------�-__--:Size: Diameter'-------------------_..De Depth------------------------ Distance from nearest weld________________ Distance from foundation_'___ Lining material” ' --.De th=_. ___--_---- .----____LI uid=Ca Capacity ---gals. ❑ � - r Size: Diameter-------=-------------------------.;. .. p f. . ---- ' - - - ..----- q P � Y---------------------•-=- 9 a Priv ` " Distance from nearest welL�_:._':_'� �_.___'' '- _-Distanee•from nearest building - ~'Distance to"nearest lot line ------.aT.� -~ � --� ---- --•�'-'--'--- ❑' "� Remodeling and/or 'repairing {describe):_ ` --------------------------_______ -- -- - * I ! r ------------"-•---------------------------------=-------------•--------------- ------------- ----------------------- ------------•--------.._•-------- -------- -- ---••-------•-------•------- _.._-______._____'________-----------.------ii-------._•_______________________________q-----_____________•___-___--_-_-_-_---_...____----_---_---______--__--_______-____-_ ____--. _-_____-__-_-______..___-..44 . ... �... I hereby certify that 1-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. s {Signed) --- --------------------------------- -s--------- --------(Owner and/or Contractor) Y:------------------------------- --- ----- -----------•--- itle];v (Plot plan, showingsize of lot, location sof system in relation to wells, buildings, etc.,-can be placed on reverse side). I " FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED BY ------------= DATE__' - -, ,d"7 REVIEWEDBY---------------------------------------------------------------------.----------`.__:------------------------------------------- DATE-----------.._-.------,..-----=----------------------------- BUILDING PERMIT ISS UED - ��A � ----�------ - ----- Alterations and/or recommendations: --- ' �------ ------------------- � ------ ----------- --------- ----- -�----- - ------"-------- -----�°/-r----- ----1----------- ----------------------------------------------- - ------------- - � . t-- te -- - . _----- ----- ------- -- -- - ----- -- -- e ,• ' t . ✓ •--- r_ i :------------------------- FINAL . -� ---- --- ---- -' FINAL INSPECTION ------ ---------- ==------ = - Date = = ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-57 F.P.CO.