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§ 'APPLICATION FOR SANITATION PERMIT Permit No. J" . --- (Complete in Duplicate) Date Issued._________ Application 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 compliancewithCounty Ordinance No. 549. ��: . .. '"JOB `ADDRESS AND LOCATIOON _..�______V ------.-------------- - Owner's Name---------- f ------------------------ Phone---------------------- ------------ Address.. ----------- Address_ ...d � --- ----------- � Contractor's Name--------- Phone-------------------� -}/ Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel Other Number of living,units: ----- -- Number of bedrooms -------- Number of baths -------- Lot size _____�-___ _______ •" --------- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ No X, New Construction: Yes J No ❑ FHA/VA-. Yes ❑ No [k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) a, Septic Tank: Distance from nearest ell--_fv-p______Distance from founcpa ion___ �+-------.Mat real____ _______________________ p ``��'' No. of compartments-- -------Sizey�r-��x-x•"Miquid depth---- -----"---------Capacity .-- + Disal Field: Distance from nearest well_-.__{¢_.Distance from foundation__,X_�......Distance to nearest lot line__ ------ Number of lines-----91 _- g � --------------- Pah . --- ------ ��--��--�C- Len Length of each line--- -8-�- ----------Width of trench- ---�`�---- Q1 Type of filter matarial___. '> C4_Depth of filter material___ _��_______Total length......._ ___Q------------------Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- . ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------- -----Depth--------------------------------- Cesspool: Distance from nearest well------------------Distance from foundation--------------.____.Lining material------------------------------------- ❑ Size: Diameter-------------- --------- -----------Depth------ -------_---------------------Liquid Capacity - - gals, f Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__----------------------------------- --- ❑ Distance to nearest lot line------------------------- - ----------------- ---------1------------------------------ ----------------------------- ? 7 - - • Remodeling and/or repairing (describe]:_��..¢_-��""-- --- -- ---------------- ----------- - -- - ------ -- ------- ------- ------------- ----- ------------- - - ---- ----------- - - - --- -------------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances Stat laws, and rules and regulations of the San Joaquin Local Health District. Owner and/or Contractor (Sigrif ELL ... Title ----------------------------- --------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------- ------------------ ----------------------- DATE ----------------------------------- DATE ---- i..r REVIEWED BY------ ---------------•---------------------------------------- 4/-- ------ - ------------- BUILDING PERMIT ISSUED-------------------------------------------- -- ----------- DATE--- Alterations and/or recommendations--------------"-------- -- ---•----------•------------------------------------------------• ----------------•--------------------- ----------------- � . --- ----------- Date_- -----------�--`�---�- ----�------ �-----�-- ------------ ------- FINAL INSPECTION BY________ 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.