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Permit No. __��•-�_-- 'APPLICATION FOR SANITATION PERMIT �� [Complete in Duplicate] pate 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 AN CATI ---- ,.. L .-- Owner's Name---=== -- ---- ------ -- - Phone ----------------------------- ---- ' --------- - --- -- --- - -------------------------- Address-'-.-.......... ------------------------------------------------------------------------------------------------------------•--- Contractor's Name------------ �?1- _- ------------ Phone----------------------------------- - will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_ ___ Number of bedrooms t;�_ Number of baths j____ Lot size �-------------- Water Supply: Public system NZ Community system ❑ Private ❑ Depth to Water Table ' ff- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No, FHA/VA: Yes ❑ NoU TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or'cesspool permitted if public sewer is available within 200 feet.] Septic a k- ' Distance from nearest well-----------______Distance from foundation__________________.Material-_______--__._..____________--..________.______- ❑ No. of compartments------ ------------------Size--------------------------------Liquid depth------------------=-------Capacity--------------.-`� ' i Dis osa Field: Distance from nearest welly--__--�_Distance from foundation_ __ ____Distance to nearest lot line___ __.____ 1 p _ � r Number of lines___________ ____ __ Length of each line-------- _____-__-Width of trench_-__ __�G____.__._________ �6 T e of filter material- Depth of filter material - � -Total length----- - ------------ 9 ---- Type �� j Q tV1 I, Seepage Pit: Distance tonearest well________________.__-Distance from foundation------------........Distance to nearest lot line-------------- ❑ Number of Pits -=----. ---Lining material----------------------Size: Diameter---- ---.Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material------------------------------------- El Size: Diameter----------------- -----Depth_---------------------------- ----------------------Liquid Capacity------------- --------------gals. Privy: Distance from nearest well ________________________`-----------------------Distance from nearest building------------------------------------------ Distance - _---___._:__-__________________.__._._- Distance to nearest lot rline --------------------------------------------------------J ------------------------------------------------------- -------- Re odelin and/ re firing (describe):---__-Jl f---- f 1 -------------- -- --------- r ________________t_ __ __-- __________r _________ _ _ - r I __ _ _ _ ___ ________ ____ ------------ -- - --- -- ------------------ ----- -- f..-- _______________ ___________________._______________________________________.-_______.__.__.._______--___________________--.______________.---____--____________________._-_________________---_____-_____-- 1 1 hereby certify that I have prepared this application and that the work will be donelin accordance with San Joaquin County ordinances, State laws, and rules and .regulations of the San Joaquin Local Health District. I Contractor) (Signed]_.------- - - -- =- - -r�---- ---- (Owner and/or on rector) By:--------------------- -------------•------------------------------- Title ---- ---- -- ----------------•---------••----------------- -- - - _ter. I (Plot plan, showing size of lot, location of system in a ation to wells, buildings, etc., can be placed on reverse side). �. FOR DEPARTMENT USE ONLY E. APPLICATION ACCEPTED BY-------------- ---- -- ------- -- - ------ ----- ---------------------------------------- DATE ,.- --- ----- REVIEWEDBY- -- -- --- -- ---- -------------------------------------- DATE- w BUILDING PERMIT ISSUED--------------------- --- ---- DATE Alterations and/or recommendations: ----=- r ----------------------------------------------------------------------------1------------------------------------------------------------------------------ --------------------------------------------------------------------------------- -------------------------------------------------------------------- ----------------------------------- ------------------------------------------------------------------ ------------------------- --- - -------------------- 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--7-2M , Revises 1.57 F,P.CO.