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APPLICATION FOR SANITATION PERMIT Permit No. fF --•- �(�C (Complete in Duplicate) d S i1 bate Issued `1 1e 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 compliance with County Ordinance No. 549. /)AluR JOB ADDRESS AND LOCATION-------------��a��------ � ---- ------ ------------------------ --- ------------ Owner's Name---------- .�-... Phone7,91 _ ------ Address.-------- ----- ------ ---- --- - --------•--- --------- - -- Contractor's Name--- ---- ------ Phone Installation will serve: Residence Ap tment House E] Commercial E] Trai er Court ❑ Motel Other ❑ Number of living units: :__- Number of bedrooms c.?--- Number of baths ___/___ Lot size _ 1� .� r -Q----------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [–] Sandy Loam [] Ciay Loam E] Clay E] Adnbe Hardpan E] Previous Application Made: Yes ❑ No X New Construction: Yes X No ❑ FHA/VA: Yes ❑ NoW i TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic•tank or'cesspool permitted if public sewer is available within 200 feet.) eptic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material------------------ __-_______-__._-____----_. No. of compartments--------------------------Size----------------------------:---Liquid depth------------------------.-Capacity----------------------- Dispos I field: Distance from nearest well-------Y______. Distance from foundation-------------------.Distance to nearest lot line_________________ [� Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material------_ O f _Total length------------------------------------------ I�N Seepage Pit: Distance to nearest well, ..____Distance from fo dation �e!Distance to nearest lot line__.---_---- Number of its------ _-Linin material-Size: Di eter-_ _____..Deptn__ ,�rr't +– Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ❑ Size: Diameter--------------------------------------Depth---------------------------------- ----------------Liquid Capacity------------------ 9a' . Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-----------------------------------------." ❑ Distance to nearest lot line----------------------------------------------- -------------•------------------------------------------------ - ----------------------- 4 Remodel• r repairing (clescribe):__:_5—e 41��_ - - ------ - ---------------- ------------ --- --------------------------- ---------•------------------------ ----------------------------------- I, ----------------------- -------------------------------------•-------------------------------------------- ----------------- = I hereby certify that I have prepare this application,*d th the work will be done in accordance with San Joaquin County f• ordinances. State laws, §. d rules a d tions the n Jo in Local Health District. (Sign _ --------";----- - --------- ------------�,nevq�?�eii, ---.(O ne d/or Contractor) 4 ------(Title __ --------- - ---- -- --• --:---. .J -- --- acs'- -------------------- By:(Plot plan, sho • size fo n of syst m in relation to yells, buildings, etc., can be plac OR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------- -- --------------------------------------- DATE----------------- t- - - ----------------------------- REVIEWEDBY--------------------------------------------- --------------------------------- DATE------------� ------ ------------------------•-------- BUILDING PERMIT ISSUED-------------------------------------- ------ --- ---------- ----=--------------------------------- D --- ------------------------- TE-- - -- Al, . and/ r o enda ' ns: -- -------- r - r -------------------------- t fy--- t/ ---- - ----- -----�----------------------------------------------------- FINAL --------------------- ------4wt/L FINAL INSPECTION BY:------------- --- -- -- Date--------- A--- - --------- ------------------ ------ � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Stree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised 1.57 F,P.CO.