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- APPLICATION FOR SANITATION PERMIT Permit No. ___ .•�1_ M (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install+he work herein described. This application is made in compliance with County Ordinance No. f5149. JOB ADORES AND LOCATION r �.. U) � `J,,-------I --- ----------------------•------ ------------------•-- ' ------------- --------------- -----. - �Q -- .; P�one------Owner`s Name-------- ---- ------------------------ ---- eAddr -------------- ---•- --•- - 1 --- n ------------- -- ess Contractor's Name------- -- -- --------------------------------------------------- --- Installation will serve: Residence ;❑ Apartment House ❑ Commercial ❑ Trailert ❑ Motel E] Other ❑ J! ` . Number of living units: Y---_ Number of bedrooms _ •._ Number of baths _I-____ Lot size __ a- ----_ -----_--____________________ I Water Supply: Public system EV-Community system ❑ Private ❑ Depth to Water Table 34-- ft. -� " Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adgbe Hardpan El. a Previous Application Made: Yes ❑ No 2-l" New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: '117 (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) . ' Septic T k: Distance from nearest well__ __1ftY�CDistance from foundation_____�r''t:____.Material_______________________ No. of compartments----- _Size `�4`U_k_`__L-iquid depth~ s _ '' .-___,_Capacity._�Q_tT._-____-_ Disposal Field: Distance from nearest welI10—)&4--__Distance rom foundation___, __._._.Distance to nearest lot Number of iines__ (f____ ___Length of each line___�_Q__`______________Width of french----____-� ___.__.__-______ ------------ - ` Type of filter materia!_ _ _ _Depth of filter material----- $_��.___:Total.length__ _[ _'_____________________ � � ' Seepage Pit: Distance to nearest 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__-___________.__________________-_._.� ❑ Size:Diameter----------- -------------- -----------Depth----=---------------- ------ ----._Liquid Capacity ------gals. Privy: Distance from nearest we1l------------------------------------------------'-Distance from nearest buildin -•_________,______________ i ❑ Distance to dearest lot line----------------------------- ------- ------------------=- k Remodeling and/or repairing.{describe)---------------------------------------------------------------------------------------------------- ----------------- --- 4 - -------•---------------------------------------------------------A.- -----------------------= ------------------------ -------------------------------•- --------------- --------------------------••--•-------------------._......---------=--------------------------F--------- --------------------------------------------------- l -------------------------------------------1_1 .. - - 1_1---------------------------------------------•--------------------------------- ------------------------ ------------------- - ----------- -- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County_ j ordinances, St laws, and rules nd regulafons of the San Joaquin Local Health District. r � � ,. (S, ned i9 ) '�` -. (�aeCts* �r Contractor) f __ (Plot plan, showing size of lot, location of system in re, ion to wells, b Idings, etc., can be pla ed an reverse side]. F' FOR DEPARTMENT USE ONLY APPLICATION:ACCEPTED BY------ ----- -------------- -- - --------------------------------------- DATE -------------------- REVIEWEDBY----------------- k------------------------- -------------------- ---------- --------------- ----------------- DATE-------------------•-•-----•---------------- •--------= BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE-------------------------- -------- -------------------- Alterati ns a d/or recommendations:--- ------- --------------------------•-----------------•--•---- - -------_-- -•---- ------��'------>` `S` • ''' ' 61 -�7� e-e r - ----- ---------- ------ G s.R. s. - - ----C____...------r ------, w � 17/ c/ys�----- �3 1:2 4.—,.`•7 FINAL INSPECTION BY:--------- -------- - =` Date-------1 --------------------•----- ----------------------------------------- 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-9-2 M Revised 1-57 F-P.CO.