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APPLICATION FOR SANITATION PERMIT Permit No. .-1d_ l (Complete in Duplicate) / 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 Count Ordinan e No. 549. r. JOB ADDRESS AND LOCATION ' --------- r -----• ---------•------ Owner's Name ------------ Phone-------------------=----------------- Address_._..------ ��_ �'1-4-----=---- Gtr' - �'` -------------------------------------- - ---------------- Contractor's Name -------------- --------------------------------- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer_ ort ❑ Motel ❑ Other [� Number of living units: -------- Number of bedrooms -------- Number of baths_____ of size _- - Water Supply: Public system ❑ Community system ❑ Private EE-'Depth to Water Table d/.S7ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M-11nardpan ❑ Previous Application Made: Yes ❑ No Ga_--New Construction: Yes �o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: p f available within 200 feet.) - No septic tank or cess ool permitted if public sewer is ava I Septic Tank: Distance from nearest well/- Distance from foundation---1-d---------- Material--- _. '- '__._______- ®� No. of compartments-_______-;1------------- -------Liquid depth------ ��-- capacity-----grt o' _______Distance from foundation____1-6---- Distance to nearest lot line__ Disposal Field: Distance from nearest well-10.6 t- t r Number of lines______-�--__----_--------------Len Length of each line_______ Width of trench..___x__51---_:______________ Type of filter material___SA/& ___Depth of filter material______-/_V ___Tofal length-----------90------------------------ Seepage Pit.- . Distance to nearest welt----------------------Distance from foundation--------------------Distance fo nearest lot line_________________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth -__-_______--_- Cesspool: Distance from nearest well-----------------Distance from foundation---_----------.____.Lining material_________________ _-____________ ❑ Size: Diameter-------------------------.------------.Depth------- -------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____._.____________________________._____._.._Distance from nearest building_-___..______-______________________- '•�� ❑ Distance to nearest lot line--------------=------- ----••-------------------------------------•----------------•---------------------------------------- -------------- Remodeling and/or repairing (describe):------------------------------------------------------ -•------------------••--------------------------------------------------•------------------------ ----------------------------------------------------------------•=--------------------------------------------------------•--------------------------------------------------------------- ------------------------------ --------------------------------=---------------------------------=---------------------------•--------------------------------------------------------------------------------------------- -------------------------- - I hereby ce 'fy that Ifriand repared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, a regulations of the San Joaquin Local Health District. Si ned -------------------------------------------------------- caner and/or Contractor) 9 }----------- --- -- ,l'r ------------------------------------------------------- By:--------------------•--------------- ``�'`'"` --------------------(Title)-- (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY --------------------------------- DATE----/.,?— �. -- ---------------- -- REVIEWEDBY--------------------------------- -------- ------:---------------------------------------------------------------------- DATE------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE.---------------------------------------------------------- 1 Alterationsand/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------•-----------------------------------------------------------------------------------------------------------------------------------------------.------------------------ ---------------------------I--------------------------•-----------------------------------------------------------------:---------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- ---- ------- --------------------------------------------------•----------------------------------------------------------------------'-- FINAL INSPECTION BY:---------- 1 }--------------------------- 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---2M Revises 1.57 F.P.CO.