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3 ; 3o W_ Ali_ APPLICATION FOR SANITATION PERMIT Permit No. .-1______7........ (Complete in Duplicate) /d/6 f� This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549. ` ---•-------------- JOB ADDRESS A LOC TION = - =.- ---------------------------------------------- I------------ /./ Owner's Name___________ �� --------------------- Phone------------------------------------ Address --•------ ------------------------------•---------------------------------....------------------------•----------------------------------------------------------------------•--- - Contractor's Name :-�--ate_._ Phone. a�_TE?... Installation will serve: Residence$ Apartment House,Q Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1____ Number of bedrooms _umber of baths _/-___ Lot size ---�2 -1-___________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 4a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No-5C New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well-6 -----Distance from foundation--- d...........Material---- .__________ ---------- No. of compartments------1'!-----------Size___x�...'_,_3 =�-"_:___Liquid de th___.• "'______.____Capacity �eo s, I Dis osal Field: Distance from nearest well. ___.Distance from foundation..-f _______Distance to nearest lot line----------------- I """ Number of lines ----___Length of each line___�tl"__fi_`______________Width of trench_._____-- --- _ Type of filter material ___Depth of filter material----.- _._Total length-------.__ 4----------------------- Seepage `--------___'___ V1 Seepage Pit: Distance to nearest well__1Aa_e_-t------Distance from fou ndation----1�--____.Distance to nearest lot line----- Number of.pits-----/---------------Lining material---12dG __._.Size:'Diameter---- - ------.......Depth-----Z___-__-__------------- Cesspool: Dis#ante from nearest well-----------------Distance from foundation---.----------------Lining material--------------------.________ ❑ 6 Size: Diameter--------------------- ---------------Depth--------------------------------------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--:--------------------------------------- ❑ Distance to nearest lot line--------------------------------------------:----•---------------------- ---------------------------------------------------------------------- Remodelingand/or repairing (describe):-------------------------------------- ------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------- ---------------- -------------- ----------------------------------------•--------------------------------------------------------------------------------------------------------- ;---------------------------------- - I hereby certify that I hive 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. F (Signed)-- L _ I-lf�J � -U '- -�"ya '�er Contractor) ------------------ BY ----------------------------------------------to- (Title) - (Plot plan, showing size of lot, location of system in relation ells, building etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r • / APPLICATION ACCEPTED BY----------- - ----------- ---------------------------------------- DATE--- GI-- _ �-�------------------------- REVIEWEDBY--------------------------------------------------/------------------------------------------------------------- ------ DATE------------------------ ---- -------------------------- BUILDING ------------- BUILDINGPERMIT ISSUED----------------------------------------------- ----------—------------------------------ --.... DATE---------------------------------------------------------.._. Alterationsand/or recommendations:---------------------------------------------------------------------------- ------------------••------------`-------------•------------------------------•-- -- _ G ! FINAL INSPECTION BY Date /U--- - -�--�•-n------ --------------- ----------- 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 Re-sed 8-'S9 F.P.Co.