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APPLICATION FOR SANITATION PERMIT Permit No. .._r1JL-Z• (Complete in Duplicate •-"- ��a Date Issued ppli ation is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein describ 1 This application is made in compliance with County Ordinance No. 549. ed. JOB ADDRESS AND CA ION"__ -------------------•------ Owner's Name-- ---- --------------------------------------------- ------- Phone Address-------- ----- - ----- ------ -------------------------------------------- ------------- ----------------------------------------------- Contracfior's Name--------- •------------------•-•:-- Phona____.- _ __ nstallation will serve: Residence❑ Apartment House [] Commercial ❑ Trailer Court ia_ Other t - Number of living units: __� ofisl � ❑ _-_ mbar of bedrooms _-�- Number of baths ! Water Supply: Public system � �--- Lot size _PP Y ------------------------ Y Community system ❑ ��Private ❑ Depth to Water Table {t• • � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam Previous Application Made: Yes No. ❑ Clay ❑ Adobe Hardpan ❑ j7 ❑ New Construction: Yes �T�o ❑ FHA/VA: Yes [] No Fj_— TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or`cesspool permifted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest �we _ istance from foun at• No, of compartments___ Materiil__" _(s t "" Size- f ��. Li uid de th q P m CapacitYZ Disposal Id: Distance from nearest well_-��_ ,(��D�stance from foundat-on � � r__�--------.D�s#ante to nearest of Number of lines-------- Length of each fine --/---- -- --�,---s�-��--r"Width of french.-- Depth of filter mate{ial.__/ -_--"Depth of filter material___ ""------`- Seepag it: Distance to nearest•well_ __ � f� f Tota! length___---/ ' + __ istance frnm foun ation___-'__ Number of pits___.-.- ��----=--Distance to nearest lot line____ ---I ? Lining material-/-fize: Diameter„�S/r � i -----------.Depth-----24 -------- Cesspool: Distance from nearest well-----------------Distance from foundation- ----------------Lining materia!_______"_____" ❑ Size: Diameter------------------------- ------Depth------ ----- -- -- -- ------- ------- �------- Liquid Capacity Distance from nearest well----- -----gals. . ___________________Distance from nearest building._--"____----,--- ❑ Distance to nearest lot line---------"" -- ---------------------- --------------- ----- --------- --------------- ----•-----' Remodeling and/or repairing (describe):----__-"- moi✓ -- -- -- --- ---- ---- --------------- -----------= ----- --- ---------•------------•--------------------------------------------"-- --------------•---------------------- ; I I --------- ---•------------------------------------------••-------------------------------------------------------- -•----------------:-- I hereby certif that I have r Y prepared thisapplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul and regulati s of the San Joaquin local Health District. (Signed)---- ---------- -- - --- ------ r -------- ------- -------- --------(9wae"a�Gontractor) ------ ------------------------ ------- (Plot plan, showings* lot, location of system in relation to wells, buildings, etc., can bel placed on -------- -- reverse e), FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ _ `'17-740 �U- - ----------------•------------------- DATE------------r= REVIEWED BY------•-•------ - - �----- - - --------------� "-" --------------- - BUILDING PERMIT ISSUED. -------- ,`-_� DATE lJ Alfa ations and/or recommendati9 :------------� ---- DA ---------------------------- ----" ls" _ •- - ------------- ------------ -._ - :_r.��__ ----- FINAL INSPECTION ----------------------------------------- Date---`'1--- .. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 5ouih American Street 300 Wes+ Oak Street ' 1 132 Sycamore Street Stockton, California Lodi, California Man}e ' California 814 North "C" Strea+Tracy, California ES--9-2M . Revised 1-57 F.P.CO" _ � 4