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d .---5 '1M APPLICATION FOR SANITATION PERMIT Permit No ------—------------ (Complete in Duplicate) �Jjr 5' 1 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 County Ordinance No. 549. JOB ADDRESS LOCATION-- 3- -------------------------------------------- -------------------------------------------------------------- Owner's NameH --------- ---------------------- ----------------------------------------------------- -------- .---- Phone------------------------------------ Address-------------------S4 -r----------------------------------------- -•---•-------------------------------------------------------------------------------- ----••-------------------------------------- Contractor's --------------------------------Contractor s Name � -T-he r✓1 ------------------------------------•-------- Phone-- C v-i7 C Installation will serve: Residence [' Apartment House ❑ Commercial ❑' Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---T- Number of bedrooms 3---- Number of baths ---f---- Lot size --lvOt�C-- ov 4--- ----------- ------------------- Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table.. -9- ft. Character of soil to a de th of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adob® Hardpan P ❑ ❑ Y ❑ Y ❑ Y ❑ ,� ❑ Previous Application Made: Yes ❑ No ❑ Now Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material------------------------------------------------- ❑ No. of compartments------------- -----------Size---•----------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well__Aav e__-.Distance from foundation--10---------------Distance to nearest lot ------ Number of lines----------4-----------------------Length of each line--;Zv- ----2'o_.------Width of trench------A 4�` ------------- i Type of filter material-Tn6--,(----------Depth of filter material---e$---------------Total length-------/o o------------------------ i Seepage Pit: Distance to nearest well----------------------Distance from foundation-----------------_-Distance to nearest lot line--.------------- ❑ Number of pits----------------------Lining material---------- Size: Diameter-----------------------Depth--------------------------------- (y Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material-------------------------------------. ElSize: Diameter-------------------------------------Depth--------------------------------- ------------------Liquid Capacity----------------------------gals. ; Privy: Distance from nearest well--------------------------------------------------Distance from nearest bui4ding-----------------------------------------. ❑ Distance to nearest lot line------------------------------------ ------------------------•--•-•-------------------------------------------------------------------------- Remodelingand/or repairing (describe)----------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------•--------------•----------------------=--------------------------------------------•-----------------------------------------------•----------------------•------------------------------------------- ------------------------- ----------------- -----------------------'--------------------------------------------.---------------------------------------------=------------------------------------------------------------- - r ` ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------- I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-----441 ------ ---------- ----/----------------------------------------------------------------(Owner and/or Contractor) -------------------------------------------------------- � t =�f:: (Title) C?- ------------------------------------- By:(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------ -------------------------------------------------------------- DATE-------- ---------------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------•------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations----------------------------------- --------- - ---------------------------------------------------------------------------------------------------------------- -----------------------------------------------------•---•---•--------------------------------------------------------------------------------------•-------------------------------•--------------------------------------- -------- ---------------------------------- ---- -------------------------------------------------------------------------------------------------- ---------------------------------- FINAL INSPECTION BY:- Date-----�f -`"��------------------------------------------ SAXJIAQUIN 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-