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APPLICATION FOR SANITATION t ..RMIT Permit No. Jp_�-'_ (Complete in Duplicate) lv� Date Issued .__l�3 __.id- Application is hereby madellto the San Joaquin Local Health District for a permit to construct and install the work herein described. This ep.plicafioriTis_macle in compliance with CountOrdinance No. 549. 2-12 - 1 d'V--- 03 �- ..E. JOB ADDRESS AND OCATION ------ ----------- ------------------- -- ------------- Owner's Name __-- __-- - /----� -----�- - - - -- -------------------------------- ---- Phone-----•--- -------------------- --- Address Contractor's Name � Phone. - Installation will serve: Residence E] A rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -------- Number of bedrooms -------- Num er of maths ________ Lot size _ Water Supply: Public system El Community system E] PrivDepth to Water Table,-___` __.___________________________----________ Character of soil to a depth!I 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No EX New Construction: Yes [ No [I FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) I Se Tank: Distance;from nearest weil__2a2____Dista ce from founda o __./0__:______.Ma�ia j - No. of compartments_._--_ Size_ �. r�_'_ epth________ _____ ZCa aci 3/ P tY Number I'from neare t weil__ .distance from foundation__�_O___-.- -.Duj' tante to nearest lot line---5c_ .._0J____ Dil Field: Distance of lines____ _____________ Length of each Iine6-O__2�'- -- Vb"' ----- idth of french------2/--'�/e!----------------- T e of filter mat rials_ �___ Type pth of filter material ___. " _- otal length-------�16-Q__________________ Seepage Pit: Distancelto nearest well________ ___________Distance from foundat-o -----------------.Distance to nearest lot line----.--_-________ ❑ {dumber of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-------------------- -----------� Cesspool: Distancei.fi•om nearest well-----------------Distance from foundation--------------------Lining material____--______________--_______-_____ _ ❑ w Size: Diameter- -------------------------- Depth----------------------- ----------;--------------L'quid Capacity-- , --------:_--:�----gals. w0 _ _ Privy: Distance�from nearest well________________________ __Distance from nearest building --------____ Distance to nearest I tc,�.11A� ------------------------------------------------------------ Remodeling and/or repairing (describe):-.__- _ , J_ •-� .� (1 ----------------------------------------------- -------------------------------- ------------------- -- --•-- ------------------------ -- I I 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. (Sig ned)---&- --�-`�-�----------- ----� -------- ------------ ------------------------ -------------------------- -- ------(Owner and/or Contractor) By-------------------------------- I ------------------------------ ---------------------------------------------------(Title)---------------------------------------------------------------- . (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. ` ---------------- Alterations and/or recommendations---------------------- --------------- --- -------------•---------------•-------------- -------------------- ----- -- ---- - ---------- ----- --- ------------- ----------------- -- ------------- _ E' � �a 'J t,C z -- ---------------------------------------------------------------------•--- FINAL INSPECTION BY:-- --- �p }------------- -- ----------------- e ------------------------------ _( SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streef 132 Sycamore Sfreet $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P.CO.