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APPLICATION FOR'SANITATION PERMIT Permit No. .lS..----- + ' (Complete in Duplicate) -.__ •----- p ) � � _ _ Date Issued _ � tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I �Applica Y ' This application is made in compliance with County. r&nance o. 549. 1` JOB ADDRESS D LOC TION_.��7z = 1 U /4------------ ----------– ----------------------- i... ----. -- Owner's Name_- -----."�`--- � • . -. Phone. -�� _ �. f Address_!_"" ' ` Phone- - __- Contractor's Name__ . ! ------ i Installation will serve: ` Residence Apartment House [I"" ng Commercial [I Trailer Lot Court ❑ Motel ❑ Other El`-- • - Number of liviunits: __------ Number of bedrooms Water Supply: Pull ics ystem _ -_ Number' of baths --- /-. size " Conimuriity".system'❑"'private'❑' Depth to Water Tabled .ft:" �'""'""'�'�""" " �. Character of soil to a depth of 3 feet: Sand" ❑ Gravel ❑ +Sandy Loam El Clay Loam ❑ Clay E] Adobe Hardpan ❑ Previous Application Made: Yes ❑ Nod] New Construction:; Yes l6 No ElFHA/VA: Yes ❑ No —M TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or' cesspool permitted if.public sewer is available wit hin 200 feet.) e Y ..�..:.. w.... - .. � Septic Tank- Distance from nearest well --------------- Distance from foundation ---------- --- ----------------------- Septic U } No.,of compartments. --•-_--- -- --- Size------------------------------� Liquid depth Capacity w.�' .' 1 t,Distance to nearest 40+ line----------------- --------- Disposal eld: Distance"from nearest well!.Distance from foundation_.-__ -----_. Length of each line:------•-----_- _ Width of trench ----------------•--------------• Number. of"lnes__-- �---------------- --- 9 ____----- . Type,�of+filter materia! -------------------------Depth of filter material ------'---------�=�-�--:.Total,length______.:_____F_---•-----•---i - ,�p� -., / s Seepage Pit: Distance to nearest well_�1 l- __Distance from f undationl_�?-'Dis#ante to nearest lo+ li • Number of,pits.- - --------- _-` Lining material_" :Size: Diameter_ ---,Z3-: ---------- Depth.., -� -- g. - - - -- = Cesspool: Distance from nearest. -well--____.'_- Distance from foundation --°-_____-.--._:-_.Linin material___._ -----------: •------- - = Liquid Capacity ------ - Is. Size: Diameter .I ` Depth F ga - 4 Distance from nearest well---_�_______________-___ ante from nearest building ---------------------------- Distance ---_. _-__-_ _---__,____----------- Privy: __ .____ Privy: ------ ----------- --- - ----- - --- �. - - --- - Distance to"nearest lot•line-----'------'--__'------------------- . D i y' :,• -,scribes Rem lin and/or repairing (de .-- -- ---- : ------------- --- --- ------------ --------•--------------------- =-------------•---- ----- I hereby certify that I have prepa-red fhis'application and that the work will be done:in accordance with San Joaquin County or St fe laws, and rules and regulations of the San Jo quip ocal Healt District. ----- ., ` _ _____ _ __ __ ______(Owner a >; Contractor) (signed) - . (Title) - -ems-= .� i showin siz f lafi, location "of system in relafiion to ells, buildings, etc., can be placed on reverse side) (Plot plan9 , FOR DEPARTMENT USE ONLY s-------- I APPLICATION ACCEPTED BY---=�1�_C�_-.,-------------------------------;---------- - - ------------------- DATE------- � - _----- ------------ , . .i { .-, DATE---- --- ----------=-------------------------•=-; --------- REVIEWEDBY z-- ------------------------------------------------------------------------------------------------------BUILDING PERMIT ISSUED ---------------------------------------- -------- Y w-= --- --- DATE ----------------------------------- Alterations and/ r. recornmen t'o s:-------- --•--- --------•-----------------------------•--------•----•---------------- ----------- ------------- t•�----------------- --r- -------------------; --- ---------------- - --------------------------------- ------- f ------------ -- ----- -------------------------- - ---- - -- ----- I ----------- Date FINAL 1NSPECTIOBY " - --- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street + +814 North "C" Street 130 South American Street 30D West Oak Street Y 't Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Revised 1.57 F.P.CO.