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v U� APPLICATION FOR SANITATION PERMIT Permit No. O (Complete in Duplicate) l-, Z -17 IV Date Issued -------------------- ApI5lication 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 i pliance/with County Ordinance No. 549. JOB AD M-ND L F- + ! -- ` " t pp 1� p v 1v ?C?f-= r 9� (�• Owner's Name.--------------" ._��T ----•-- am----- Address-------------------•- '�=S , = =�!1=`` - °�- F�', Contractor's Name----------•------- ;., , ---------. J. . r Y ,. P -------- hon , •-------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court'❑ Mote ❑ Other Number of living units: I------ Number of bedrooms __!-___ Number of baths I---- Lot size _1_ , .' j U i Water Supply: Public system ❑ Community system E-] Frivate Depth to Water Table __`-1ff.4e -(444 j Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam L,] yCl'ay ❑ Adobe ❑ Hardpan p Previous Application Made: Yes ❑ No 9? New Construction: Yes �No ❑ FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic fank'or cesspool permitte 'if pu6iic seweris available w thin 200 feet.) - " Septic Taannk: Distance from nearest well- � �"-----Distance from foundation__b----_____- MateriaL�__�._� U t'�•__-"-" a No. of compartments----2rrn---------------Size__ _ --- :_..Liquid depth----- ------------ ---Capacity--- -- Disposal -ield: Distance from nearest well_tS� .__-___Distance from foundation----- _`______.Distance to nearest lot Number of lines_____� 4-0. t cc Length:of each line______ Ft-----;-Width.of.trench__P__il_ Type of filter material___ - ------Depth of filter material ____L�'.= ____" Total length___--_-G-;_s________._ --------------•- q� Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______.____._,_ (,\ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-- .--------------------------- Cesspool: ------------ -Cesspoo€: Distance from nearest well----------------- from foundation-------------------- material___._-_____________________ Q ❑ Size: Diameter------------ Privy: -------- -----------Depth:------------------ Li '.d Capacitt gals._4 ------ ----- Distance from nearest well-___ .------------------------------------------Distance from nearest building ' --------------------- Distance to nearest lot line--------------------------------- Remodel- and/or rgpairi ascribe :__ --------- .� --,i,� - tr- - ------------------------------------- -- - ------------ -------------------------------------- y -----------------------------------------------------------------"------------------------------------------------------------------------------•------------•--------:--- ------ I I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, Stats, and rules and regulations of the San Joaquin Local Health District. (Signed)-- --- r?_---- (Owner and/or Contractor) ----------------------------------- - ------ ----- --- --- {Tie --------- (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------ [t� -------------------------------------"------------------------------- DATE----- - REVIEWED BY----------------------------- --------------------------------------- ----- DATE BUILDING PERMIT ISSUED---------------------------------------------------- - -- ---------- ------------ DATE Alterations and/or recommendations:--------------------------------- -- ---- - ---------_-----"------___" -----------•--------------"----•--=------------------------------------------------------------------------------ ---- ----------------------------"-------------------------------- -------•----------------------'-------------------- • --- -----•------------------–------------------------ ----- { ---------------1--------------------- ------------------------ -- ------------------------------ FINAL INSPECTION BY:-,---- ------ ---- - ---- --- - ` 4• i Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 7.57 F.P.CO.