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161 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) I1 This Permit Expires 1 Year From Date issued Date Issued _______ 3 ______; / _�P 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 AND CATION. '-------��-- --- - -- ----Z--f------ -"- � --- Owner's Name------------- �- Phone_.. Address--------------- ---•------------------ J=---•--.._..._.------ ------------ Ol _ ------------------- --------------•----_ -------------_- Contractor's Name--------------.------------------_--------------- ---------------- Phone Installation will serve: Residence ,K Apartment' House ❑ MTnmercidl ❑ Trai er Court ❑ Motel ❑ Other ❑ Number of living units: ____/._ Numberf bedrooms '��lumbe of bat s _�/--__ Lot size ------------ -------------------- v Water Supply: Public system ;Z Community s m_D_.Frivate E]Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E❑ Gravel El Sandy foam LK Clay Loam El Clay ❑ Adobe C] Hardpan ❑ Previous Application Made: Yes 0 No [f "New Construction: �� No ❑ FHA/VA: Yes ❑ No. TYPE OF INSTALLATION AND SPECIFICATIONS: T t~ (No septic tank or cesspool permitted if public sewer is availa le�w14hin 200 feet.) Septic Tank: Distance from nearest well ---- _____Distance from four; ation____,-'_ra_-'_._.Material _____ ____________ __ _____- ------- No. of compartments -----.-----2 .- Si .--- 1.�' ---�J Liquid depth----------- — ------Capacity------ �J-- - N L r �' .1, __.._.Distance to nearest lot line_______l__© d Disposal Field: Distance from nearest well______--- Distanceafrom foundation___...,?'. - Number of lines ------------------- �-------- Length of eJ h..IinA ----------- oe -------- Width of french --------- L�—'= ------ Type of filter material__,____Depth of fi%%11e""m��aterial____--`_'_____Total length___._______,! Z________________ Seepage Pit: Distance to nearest well ____________.______--Distance ffom foi€ndation ------ ._-_._______.Distance to nearest lot line_________________ ❑ Number of pits ---------------------- Lining mafNat-------------._. S Diameter Depth f ize: Cesspool: Distance from nearest well_________________Dista�re from f6undlion___.________-----..Lining material ------------------------------------- ------------ Size: Diameter--------------------------- p-------------- 41 -------Liquid Capacity gals. Det R ' ____----Distancce,from nearest buiidin ii Privy: Di nearest well--------------------- ------- 9 I ❑ Distance to nearest lot line--------------------------------------------------------------------I----------------------------------------------------------------------- Remodeling and/or reairing (describe)- --------------- - -' --�-f ------------ ---- i----------- -------------------------__. xa'__ w. ----------------------------------------------------------`--- ------ - --------------------------------------------------------=----•-------------------------------•---------------------------------------------------------------------- ------; ----------------------`-------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and'ru es a regulations of the San Joaquin Local Health District. r t i Si ned _.--------(Owner and/or Contractor) By:--------------------- I-------- ----------- ------------------------------------------------------------------------------ r --------(Title)------------------------------------------..... ------------- (Plot plan, showing size of `1,0#,'1'catioyNof 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------- ---------------------- ------------------------------ Alterationsand/or recommendations:--------------------------------------------------------- --------------•------------------------------------------------•---------------------------------- ----------------------------------------------------•--------------•------------------------------------------------------------------------ ----------------•--------------------------------------------------------------- -------------------------------------•-----------------------------------n----------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- FINAL INSPECTION BY------- ----------------JI`--'---'--r-- 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 -9-2M Revised V59 FT.Cc.