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APPLICATION FOR SANITATION PERMIT Permit No. SS'z (Complete in Duplicate) l 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 AND LpCATION_� ..... - _ M ------- Owner's Name ---------- Phone--------- Address------ -------Address------ ----------------- --------_----••---•-----•-•--------•-•--•-•---- •--• -•----...--•- Contractor's Name ----------------------------------- Phone ------------- Installation will serve: Reside e A rtment Nouse ❑ ommercial ❑ Trailer Court ❑ Motel E] Other Number of living units: ____L Number of bedrooms ---3- Number of baths J---- Lot size ._``___[___1:C e �..,,.------______________-____ Water Supply: Public system El Community system E] Private Depth to Water Table �TQ_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ NoX New Construction: Yes ❑ No$ FHA/VA: Yes ❑ Noz TYPE OF INSTALLATION AND SPECIFICATIONS: -r�aCA 1 (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) n-,Se tic Tank: r distance from nearest well___3e�______Di nce from found{afion____S______.__._.Material-__ ___-__o. of compartments__-r ._ - ____ �_?C__-_ ,._Liquid depth________�.4-_-___-Capacityi70_-- p posal FieEd: Distance from nearest well__ 0_-_Distance from foundation___ -------- Distance to nearest lot lie_a--_�. ' Number of lines---------I�________________________Length of each line__AZ—_0a__�+--------Width of french__-_2,14-//_______._______ Type of filter material_ .___Depth of filter material____1-9___.........Total length-------A©_-0____________________ Seepage Pit: Distance to nearest well____________________Distance from foundation_,!.....___.....__.Distance to nearest lot line_-___-___________ ❑ Number of pits----------------- ---Lining material-----------------------Size: Diameter------------------------Depth--------------_-------.---------- Cesspool: Distance from nearest weld-----------------Distance from foundation--------------------Lining material-___.__,_-___________,___________--. F] Size: Mameter--------------------------------------Depth-----------------<------------------------ ------Liquid Capacity------------------------•--gals. Privy: Distance from nearest well--- ___ _ -- _ ----- D• ante fro nest buildin _:____ _____________ _ __GQ.----. ❑ Dis nc nearest lot line------------ ------ -- Z---"'+--- --••--------------- ----------- � ' ' oc Remodeii g and or repairin describe)-_ �Qr-._______•--.._------- - -- - 4 - s- f e9'-� - -- - -fes--- - --------------- - -.. .--- -- ---- - ------ r`� �/� - - I hereby certify that I have prepared this application and that the work will be d4ine in accordance with San Joaquin County ordinances, 5t to laws. and les and r�u�t' �ffhS n ,laaquin Lq�al H�elthBrc(Sign ]-- .. .W,12, _ y! .7---------- - - -- - ------------------------------------------------------ ----------------------{Owner and/or Contractor) By:. e!°.c1.45' -------- (Ti+le)----------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY C APPLICATIONACCEPTED BY-------------------------- -•---------------------------- -----------------------•--•------------- DATE------------------------------------------------------------ REVIEWED BY----------------------------------------------- --------- DATE------- - BUILDING PERMIT ISSUED------------------------------------------------ DATE----------------- -------- - -- Alterations and/or recommendations:--------:--------------------------_v._<-.�_ - ---- - _------------------------------ --•- --------------------------------------------------------------------- --------------------------------------------- ----------- -------- -------------------------------_------------------------•------------------ ------------------------------------------------------------------------------------- ------------------------------- _ �--------------------------------- - ---------------------------------- ---------------------------------------------------------------------------------- J r - ----•--- / a FINAL INSPECTION BY---------------- ------------------------- --------------- Date-------- � � 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-9-21x1 Revisea 1-57 F.P,CO.