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p APPLICATION FOR'SANITATION PERMIT Permit No. (Complete in Duplicate) Date IssuedT_� 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-rrAade in compliance with County Ordina ce No. 549. JOB ADDRESS AND CATION-------- = - ---- - ------ -------•------------------------------- - •----------- Owner•;'s;Name_____ • - - •- -----�-�&---- � - --------------------- one_ _r -•-- --1 fit..' Address---- --- ---------------•-•----------------------------------- --- - -------- ---------- Contractor's Name---- -- - =°`r ---------- --------- Phone Installation will serve: ' Residences A rtment House ❑ Commercial ❑ I railer Court ❑ Motel-. Other ❑ Number of living units: __r_ Number of bedrooms Number of baths ____ Lot size .__-1%.�� ------------------------ Water 'Sup P ly:' ----------------------- Water'Supply:' Public system - Community system ❑ Private ❑ Depth to Water Table 0-161 ft. Character of soiloto-a depth"of 3 feet: Sand F] Gravel El Sandy Loam [1] Clay Loam F-1ClayE]AdobeW Hardpan ❑ I Previous Applicati n'Made:� YesR No ❑ New Construction: Yes ` No ❑ FHA/VA: Yes ❑ Nox TYPE =OF ,INSTALLATION AND SPECIFICATIONS: ' (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from,`nearest welE,�-___Distance from; f un�atior;_/.&- ---- _ ___----- Na. of compa-rtments___--Z_______________Size_,iquid depth_ `_,__Capacity____ ------ Disposal�Fielci: Distance from nearest well_/rs-e"___: Distance from foundation_ 4�'Z" _ _____-Distance to nearest lot line ----.;5 ---f_:__- ". Number of lines -------- t-------------- - Length of each line __-_----�l�________:__.Width of trench._____-.__._______-_-.___.___ Depth filter` material__-__ ___ __ __ Total length Type offilter material _ p % _ s� ----- g --- - r 1 Seepage Pit: Distance to'nearest well,,_-�________Distance from f ndation__/e_ �__ .-_...Dista nc a to nearest lot line _____.�_�__ _ Number of pits_ _____ -_._______:_-Lining mate ria l Size: Diameter__._,�_-________.Depth____�.1C Cesspoo€: Distance from nearest well________________Distance from foundation____________________Lining material-_--__-_----______________________._ Size: Diameter ----------- #----------------- ---------- Depth----------------------- : --- ---Liquid Capacity Privy: Distance from nearest well______________ ___ -- from nearest building___________ V' ❑ Distance to nearest lot line---- ---_:`--- -=--------------------•------------------=----••----------------------=----------------- ------ Remodeling and/or repairing (describe}:L2:tT-----------------------=------------------------------------------••----------------- --------------------------------------------•----------------------------------------- } -----------•-------------------------------------_---------------------------•------------------------------------•----------- i ------------------------- ------------------------------ 1 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 rule and re ulatio of f San Joaquin Local Health District. -----------------------------------------(Ow and/or Contractor) (Signed)-- t ____------------k . li --,- -- - - - - � -- }Tiff. - - - ----� -- ---- •--- (Plot pf n, size of t, ocation of system in relation #o wells, buildings, etc., can be placed on re se side}. j FOR'PEPARTMENT USE ONLY APPLICATION ACCEPTED BY � - DATET °� �•---- REVIEWED BY DATE:. --------------------------------•--•----------- BUILDINGPERMIT ISSUED----------------------=---=----------------------------------••--------------------------------------- DATE------------------=--------=-------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------•-•--------------------------- ---------------------=-------------------------------------- --------------------- ;---- --------------- --------- .... > --'------ --------------- -------------------- s -.-------------------------------------'----------- ----------------------------------------------------------------------------------------------- - ------------------------------------------ I FINAL INSPECTION B --------------------------- - Date -----�� Q , SAN JOAQUIN LOCAL -HEALTH DISTRICT 130 South -American. Street 300 West Oak -Street~ 132 Sycamore Street 814 North "C" Street Stockton, California, - `E ;Lodi, Califoroia-� ' Manteca, California Tracy, California ES -9-2M Revised 1-57 F.P.CQ. .:�"