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>f ti q ) -.. Permit No. APPLICATION FOR SANITATION PERMIT ry (Complete in Duplicate) (i I 6�1 y 7 Pate Is!ued ---- ?/v N` A {' pp kation,is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiori.is made in compliance /with County Or inance . 549. JOB ADDRESS AND L TI L I _ 1 Owner's Name_._,_____ = ---- -------- Phone------------------------------------ Address ------------ ---------- ------ - --------------------------------------------------- ------------------- Contractor's Name---------- - .._ Phone----------- Installation will serve: Residence W'-`Apartment House f] Commercial ❑ Trailer Court ❑ otrel ❑ Othe Number of livingunits: -�--- Number of bedrooms � t -- Number of baths _/.-_ Lot'size .--- Water I Water Supply: Public system I]"' Community'syst&n ❑ Private ❑ Depth to Water Table s ft: I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ..Adobe Eq--Mardpan ❑ i Previous Application Made: Yes ❑ No [t�New Constructi_ on: Yes P91"go ❑ FHA/VA: Yes ❑ N1 o TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.)_ r Septic Tank: Distance from nearest well-/ '�--Bistance f om found tion___./.__-_Material.-.,�_// �O__ No. of compartments--_ %�_ _ _______________Size__ - (�--Liquid depth__ _ Capacit ._ —f- 4 Disposal Field: Distance from nearest wefi--&"----Distance from foundation________ _________Distance to nearest lot lin Number. of lines------- _--,_.__ __ ength of each line___ ________wdth of trench_--,--- �a lr Type of filter materiaL �-_/ !_ -Depth of filter material___..� __:____._Total length----- , ------------------•------- Seepage •,__-• See a e Pit:-" Distance'to nearest well__ _ __.__-Distanco fr m un tion__ f p g � �i Q ��.~.....Distar;� to nearest lot line--.4�- ----- Number of pits_______ ____________Lining material`--- ize: Cesspool: Distance from nearest well_________________Distance from foundation---------------------Lining t material__.__--___._______-.____.__---____ ❑ Size: Diameter------------------------ --------------------------------------- Qu . th - ---- Li uid Ca acitY------------- -----------•--gals. Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building---------------------------•--- -- ❑ Dis+anee to nearest lot line --------------- ---- ------ = M Remodeling and/or repairing (describe)________________4 - - , ---------------------------------------------------------------------------- -------------------------•-----------•--------------------------------j- ---- -----------------------------------------------------•------------------------------------------------------------------------ _ I hereby certify that I have prepared this application and that the work will be done in accordance with San' Joaquin County. ordinances, State lawsA�ol and regulations f the San aaquin Local H alth District. -; .y (Signed) ------------- Abnoif � f Contractor) By: = ------------------------- (Title}_- � - (Plot plan, showing size of lot, tom inrelation to wells, buildings, etc., can be placed on revers de). FOR DEPARTMENT USE ONLY 1 APPLICATIONACCEPTED BY--- --------- --- _--- --- - ----------•------------------------------------------------- DATE-------- ----------------------------- REVIEWED BY------------------------------------------- ------ _ DAT ----- r BUILDING PERMIT ISSUED ----------------------- DATE------- l� .._ .+ y Alterations nd/or recommen tion :--- ------ --------------------- ------ ------- 'r -•------------------•--- ---------------- - / ----- .--- ` = --- -------------------------------------- i FINAL INSPECTION BY:.- - -- ---- ----------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American•Streat 300 West Oak Street 132 Sycamore Street * 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California t ES---9---2M Revised 1.57 F.P-CO.