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APPLICATION FOR SANITATION PERMIT IF_ Permit No_ ____ (Complete in Duplicate) R - '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 mad e.incompliance with County Ordinance N 549. JOB ADDRESS AND LOC TION___ __ Owner's Name -- ---- V ------- Ph . �` _ ____ _ _ _ ______k__-_- ______F -___ 7 --------------- one_ d. r3_. . Address. ) l -------------------------- Contractor's Name)_____ ` x t ------------- -- --- ------------ Phone----••---------- Installation will serve: Residence ❑ Apartment House Commercial Trailer, Court P � ❑ �❑,•„_Motel ❑ Ot�r ❑ Number of living units: �__ _a. Number of-bedrooms _/! Number of baths __ � Lot size y yr. i ; tic3 rr� - Water Supply: Pubic s stem Co-Commu *'s st m , ;t ❑' Private❑ Dep4h,to Wafer Table ______:_ ff: Character of soil to;!a depth of:3.feet:36and j].. G,ra el . ,,.Sand Loam_ i � �4 ❑ y, ❑�CIay,Loarn `" lay ❑ Adobe Hardpan Previous Application Made:. Y s N ❑ rNew`Constructio is Yes ❑ '�No'k,t-FHA/,VA: Yes ❑ No ❑ TYPE OF INSTALLATION.AND SPEaFICAT10N5: c (No septic tank or`cesspool permitted if public sewer is available within."200 fe k; et Septic Tan . m istanceio �nea}est wll--____-_ ___Distance from faundafion________________ Material------------------ __..________.___---_ ❑ o. of compartmenfs---- ---- - Size p---------Liquid depth------------ CapacitY -- ----------- Disposal Field: Distance from nearest well ' W{. Distance from foundation-_ - -___-_-_Distance to nearest lot line...... _ .---•- Number. of fines -: -Length of ea'Ch line_- _- �j 3 ?'Width of trench-_.----., _f lu ype of filter mat T ial Depth of filter material f ---------- -o'al length__. _ 9 eepage Pit: istance;to nearest well -------- --------Distance from foundation__-. ----------.Distance to nearest lot line_______..-______El . Number,'of pits------ _- _----Lining material__.--------- ------_-Sized Diameter-- i `----- ------- Depth............ - 4 —4 p islancel,Trorri nearest well pistance from foundafiori_____ ________ ___.Lining material__. _ ____ Mo •Size: :' . -------- Priv❑ Distance De fromr n�ares��lI___ �----------._De�th------___._:'__ _-_Qisfance from Liquid Capacity._______.-_---•--------•---gals. dry Privy, om nearest building___________ ❑ Disfance-to nearest 1ot`me___;___________ Remodeling and/or repairing (de ----- ------------- scribe x i •----------------- -------------------- ---------•-----------------_---=----------•------,I------------------------------------------------ --------------•------ I hereby certify that l have prep :ed fg; application and-that the work will be done in accordance with San Joaquin County t ordinance;, State laws, rules a regula#ions of the San Joaquin Local Health District. (Signed) (Owner and/or Contractor) r C ractor) : .f' f t (Ti I ----------------------- --• t (Plot plan:;showing size of-lot, location of system in.relation to wells, buildings, etc„ can be placed on reverse side). �t FOR DEPARTMENT USE ONLY f - ----• DATE `. .._ . APPLICATION AC�EPTED-BY . --- ---- -------�, � ` �z e REVIEWED BY = ik --------- DATE-- f / BUILDING>_PERMIT ISSUED------------------ = DATA :: ------ Alterations and/or recommendai'}ons:__ '----------------- ------ -----••----------- h ----------------------- E+ �` ----------•--------------------- .------------------------------------------------------------------------ --------------------- --------------------- _ ----- -- _ k FINAL INSPECTION BY:._ 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.