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APPLICATION FOR SANITATION PERMIT Permit No. _ �"�- __•_ it �� (Complete in Duplicate 1 Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct a d install the work herein described. This application is made in compliance with County Ordinance No. 549. 0 :S-_ 8C.. 4 0 Ae�O f O n S'T JOB ADDRESS AND LOCATION------- --_�E " /&----/--v----. Owner's Name--- -- ------ --- ------ -------- e_ ;Z --- --- --- ---------------. Phone---------------------------------- Contractor's ---r------------------ ------/-- •- Contractor's w. Name--------------- ,[ f�•:R Phone�Q_.--P L_40 Installation will serve: Residents ❑ Apartment House ❑ Commercial ❑ Trailer Court ` ��❑,� Motel ❑ Other E]Number of living units: __/._ Number of bedrooms -__Number of baths ._--&Lo?si!!��b" ------------ Water _Water Supply: Public system ❑ Community system ❑ Private 2--Iboepth to Water Tableqpw ft, /f i Character of soil to a depth of 3 feet: Sand ❑,Gravel ❑ Sandy Loam ❑ Clay Loam may ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes p No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if pyidic ewer is available within 200 feet.) ` Septic T : Distance from nearest well_ __4---__--_Distance from foundation--/O --------- -Material_ -------- No. of compartments--_--. -`- - _1—-----Size-6T �,6__�---Li Liquid de th---� rr q p -�----- ----Capacity-, ---�•---- Disposal Field: Distance from nearest wel!_" Dista rom foundation-_ _d� -. ---.Distance to nearest lot line----- ----- Number of lines_-"""_ _"-._ Length of each line-_--- "" g �e�--- --�f Width of french --------- --- Type of filter material . Depth of filter filter --/ ---------eleTotal length-"_"""_ """ `----------------- Seepage "" rj See a e if: Distance p g to nearest well___L 0--_---"Distance from foundations- � C, + .. """._._"_"_.Distance to nearest lot line_-�.!_._-"____ Number of pits.--_-I--__--- --"-_Lining material-- - ---_- -- --- Size: Diameter-" �� / �,�------- --Depth--.c�,� ----------•-------- Cesspool: Distance from nearest well----------------- fro foundation__-----_----------.Lining material--------,---------_-_ Size: Diameter---------------------- -- ------------De th--------------------- ------------------ Liuid Capacity p ---------- q -------------- -------------gals. La Privy: Distance from nearest well--------------------------- " ---;_..Distance from nearest building ❑ Distance to nearest lot line---.---__----_,_""" Remodeling and/or repairing fdescribe)----------------------------- --------------------------- --------- ------- ------------ ----- - -------------------•---------------• _ I hereby erti that ave pre a d this application and h t the work will done in accordance with San Joaquin County ordinances, St to aws, an ';rules an gulations of the San o quin Lo al Hea District. .o (Signed)--------- -- • - - ---------------- ---- -------- weer-aa Contractor) BY: -------------•-------------•-•------ ------- - -- ------- - "{Title)- c (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., an be aced on reverse side). FOR DE TMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------------- DATE �.. REVIEWED BY,,;, y '- r► -- --------------- -------- DATE -j -------------------- BUILDING PERMIT ISSUED--------------------------------�- ` •-------------- -------- ---- --------------------------- AI}erations and/or recommendations:"""___._.__"_""" "__"_"""_.""""__ --------------------------------------------------•---•--- ---- U _� -----------•----------------------- --------------------------------------- �' ------------------- t ... 4,.--<- -:---------)---)c----------------------•------------ ----- ----------- FINAL INSPECTION BY:------ -- ---- Date7---- - ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manfeca, California Tracy, California ES-9-2M , Reviseci 1-57 F.P.CO.