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f A,P _f� c APPLICATION FC.-.,SANITATION PERMIT Permit �y (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �- JOB ADDRESS AND LOCATION-----Zg _<7__,4...... ,Z - .c /tv-.- ------------ Owner's -Owner's Name-- :_ • ------ --�-=-.-�----w-- ----------------.-u--_-.--f------ -- �r-----------------------------------------------------------------------------------.- ------------------------ Address ----P--h--o--n-e----•-----------------•" ---------------- ---_____-- � --•-----------= Contractor's Name r --------- Phone- Installation will serve: : Residence [9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of livin units: -- g _-- Num of bedrooms -.,.7_- Number of baths --/-_ Lot size ----- /_-_�C---/. 'r-- - -_-__----_ Water Supply: Public system 4" Community'system'❑� Private FI—Depth to Water Table 4`_ ft. Character of soil to a idepth of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay.❑ Adobe ® Hardpan ❑ Previous Application Made: Yes ❑ .No [Z New Construction: Yes [N No ❑ FHA/VA' Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: 'Distance from nearest well-----------------Distance from foundation---_------------------Material -----.-_._-______---------___-------- No..of compartments--------------------------Size---------------------------------Liquid depth----------------"---------Capacity--------•- Disposal Field: Distance from nearest weft--------------- _Distance from foundation-------_-------_-----Distance to nearest lot line_-.-----._--_-..._ R --- -----.Width of trench------- = .r ;.Number of lines----------------------- Length"of each line_----_--_-.-----___ Type'of filter material------------------------- of filter material----------------------- length------------------------------------------------ Seepage -__------.----_--.-.---------_-__-------- Se� e Pit: 'Distance tonearestvell2Zo_-Zr a—Di lance from f undafionl _ Distance to nearest lot line p g - Number of its--------__ - al--/<d�` -- Size: Dia eter----- -'i- Depth--------------- � -- - - \ 3 � Cesspool: Distance from nearest well-----------------Distance from foundation----------------___Lining material---------------------------_--------- ' Size: Diameter-------=- '------ -------- --------Depth--=----------------------- -------------------- ----Liquid Capacity----------------------------gals. Priv Distance from nearest,well--------------_---------------------------------Distance from nearesf building ❑ . .-Distance to-nearest-lot line-_-_� :- ^- ' o Remodeling and/or repairing (describe):_-.:_CZ, -tea -----------------------------------•----------------------------------- ---------------- d ,- _ . 1 t I t I hereby certify'thaf;l have 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. —s-�----------------------------------------------(Owner and/or Contractor) t By:._,Z_66-..-_-------------------------- ---------•-•------------------------------------------------------------------(Title) � J (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reveside). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------'--------------- --------------- ------------------- DATE------------------- REVEEWED BY- DATE---------------- ----- - ------ ----------------- . -- - - s . BUILDING PERMIT ISSUED ----------------------- Alterations ---------------- DATE----------------------- " Alterations and/or recommendations------------------- ---•--------•--------------•----------------------------------- -------------------- = ----------�V ;' -- ---------- --- ---------- - r-L6--------- ---- ----•-•------ --- - -- -- - ------------------------------------------------- -••----------------------._--.. - ----- ------ ----- FINAL - - ---------------------- ------------- ----------- - - FINAL INSPECTION BY _-_r_ - __ Date--. - -- -- �_ --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 4¢ 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-57 F.P.CO.