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eirvl 0- APPLICATION FOR SANITATION PERMIT Permit No. .-..J.- -_ _ 0 L� (Complete in Duplicate) r/ Date {sued .--��__-d `• 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, JOB ADDRESS AND LO ION-------------Y__[ -'-----_SU- I -1 - _T-------------------- ---------------------------- Owner's Name---------------------5-- ------- Phone`-ZID--�f ---------------------------------------------- Address_-------------- -�-..-------��-•---•-----•- _ _� T�= , Contractor's Name-------- ---------------- Phone,. -- -L�- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-- --__ Number of bedrooms _4-Number of baths --/_ Lot size Wafer Supply:Supply: Public system Community system ❑ Private ❑ Depth to Water Table _Ie/ot. Character"of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes E❑ No [�" New Construction: Yes E] NoA FHA/VA: Yes ❑ NorTYPE OF INSTALLATION AND SPECIFIIC`ATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) r�� s, Septi Tank: Distance from nearest well_----_✓ A/41 istance frQJr1 foundption-_- -----__Material f----.-__--- fG No, of compartments----- - ________Size-- -- .---Liquid depth_.----, -------_-----Capacity- --��-�' Disposal Field: Distance from nearest well... .Distance from foundation___�7 Distance to nearest lot line---Jd--... r-------- te Number of lines--------/------ ---- --------Length of each line--_____-CV--- r•Width of trench----- ,-[ __------_ Type of filter material--- QL/li---Depth of filter mate rial_.-._/_------- Total length---- 'V____------- ----------_ See a e Pit: Distance to nearest well--- ---Distance fr m foundation---_& -__-.Distanr�e to nearest lot liner------__ Number of pits..._--.-------------Lining material___--- Size: Diameter__..-..?9 - Depth_-a -_-_---__-.-. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---___----_---___-----_--___--_-----. ❑ Size: Diameter-------------------------------------Depth------------------------------ ---------------------Liquid CapacifY-------------------------- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------_- - ❑ Distance to nearest lot line 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, State laws, and r e and ulation San Joaquin Local Health District. (Signed)-------------------------- r =------ - ------ ---- --- - - -- --------------------(Owner and/or Contractor) BY: ",:_= -----J--------------------" (Title) _ -o (Plot plan, showing size of lot, location of Sys in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ------- DATE--------------------- - !� -------------- REVIEWED BY----------------------- --------------- --- ---- --- ----------------- ----------------------------------------- DATE----------------- --•---- T- • ------------------ --- BUILDINGPERMIT ISSUED - --- --- -- -- •----------------------------------------- DATE---- -- 7 Alterations and/or recommendations:-------- - ------------------------- ------------------------------------------------- ----------•---- - •-------- .. - ------------------------------------------------------- --------------- We FINAL INSPECTION BY..-- Date y J --- ----------------- SAN JOAQUIN CAL HEALTH DISTRICT 130 South Arnerican 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.