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� . APPLICATION FOR SANITATION PERMIT Permit No. .__"-c�__�-_—___ (Complete in Duplicate) / 'r Date Issued --- ------------- Application -- S_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 LO ATl N__________ __ ---- -`--- ,!-`-'r elJ T� Owner's Name--------- ----------------------------------------------------- Phone Address---"_-_-"" - l ----•----•----- - Contractor's Name--------------- - - * ----- Phone - r -------------------------------------------------- --------- Installation will serve: Residence ❑ Apartment House [] Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: _> Number of bedrooms _ _- Number of baths _-&*� Lot size Water Supply: Public system 'PCommunity system [I Private [1 Depth to Water Table 'k ft. i Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [-] Clay El Adobe �ardpan ❑ Previous Application Made: Yes E]I. No New Construction: Yes 2R-'lo ❑ FHA/VA: Yes ❑ No ®r" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 fee . Septic Tank: Distance from nearest well_{ ?'Distance rpm foundation---- � ------.Materia(----- ." //�� Size__ E/ .1e -------- ---- �~ No. of compartments ate. Liqui , epth--, -----------------Capacity-ZA&P Disposal Field: Distance from nearest well-`k"__X ( stance from foundati �_-----Distance to nearest lot hne`_,.Z,_--- �- Number of lines_"- .- -_ -" Length of each line-___- "" __-___ Width of trench------�_�y_G__ S ------------------ Type of filter material _ - ___ ---Depth of filter material---" -- length length------'"p--------------------------- Seepage Pit: Distance to nearest well__rAV_7C/�Disfance f;pm f ndation___._- -----•-- Distance to nearest lot lin ---_------- a� [ate Number of.pits--I--> Lining material"-- -_ __-- --- _-Size: Diameter"�q1gg----«---------Depth----- ------------- Cesspool- ___-- """--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------- -"-""" \rt ❑ Size: Diameter-- I---------------------------------Depth----------------------------------------------------Liquid Capacity'l,= -------gals. Privy: Distance from nearest well__--t-____------------ "________-_---------_Distance from nearest building----__--`-_+.____ ❑ Distance to nearest lot fine"""""_____-"-" `" Remodeling and/or repairing (describe)----------=--Aa - - --- ----------------------------------------------------- ----------------------------------------- ----------------------------------- - ----------------------------------------------------- _..----------- ----- --- - -------- ---- - ---- - --- • - I hereby certify that I have prepared this application and that'the`work will be done in accordance with San Joaquin County ordinances, State laws, and ules and regulat'ons of the San Joaquin Local Health District. (Signed) - �. ---- - ---_- ---- - --- --------- ------------ Contractor) By----------------------•.------------------- ----------- -- -- ---- - (Title) `�--. -------- (Plot plan, showing size of lot, loc n of system in relation +o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ----------------------- DATE--I-------- ; ------------------ REVIEWED BY --------- ----- ------------------------------------------- DATE__ i BUILDING PERMIT ISSUED------------- Alterations - ---------•-------------------- --------•-------�--------------------- -------- DATE-----�---•-- ----------- -- Alterations and/or recommendation Y�__-_ (�- - --------------------------- ------•----------------------------------------------------------------------------------------------------------------------------------- ---------------•------•--•------------------------------------ •------------------------------------------------------ -------- r� �-y FINAL INSPECTION BY:---- ------ ADate 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 , Revised 1.57 F.P.CO.