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APPLICATION FOR SANITATION PERMIT PermitNo. ._. _J__6.Z (Complete in Duplicate) 1 x _ q 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. 1E(.1Et)4g,j-rW ST , JOB ADDRESS AND LO TION . ------------ ---- �-- Owner's Name__-- - �-- fE------ --- _---------__ --------------------------------- - _ Phone_ Address----------- Contractor's ---------Contractor's Name----- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercials' Trailer ourt ❑' Motel LlOther Ll Number of living units: __.-- Number of bedrooms __—. Number of baths -------- Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan El Previous Application Made: Yes ❑ No bd New Construct' n; Yep Q No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 4- (No septic tank or'cesspool permitted if public sewer is available within 200 feet�T11 i Septic Tank: Distance from nearest well-1-00-or foundation_± J f�- ter' K-NNo. of com artments__-_ _`"' Li Liquid Capacrty._ -G4-O_ Size 1' ---------------� -- --`---- --- q d depth------4--�. - �l Disposal Field: Distance from nearest well--[.- -_�--_ �f�V I- ""'� p �" __ Distance from foundation____ _____ ___ ___�i5tance to nearest lot lin��_SD_--- [ Number of lines------------ r-._________----� Length of each line---------+ �------- Width of french.---!?t4-=------------ ----- 1 Type of filter material___ T,17RAt_Depth of filter material ____1_--4----------Total length------1C�-49----------------_-__-- Seepage Pit: Distance to nearest well__S-D--_---Distance from f un A n___r-_-- f � .� Distance to nearest lot gline--�C> Number of pits ,� material _ . 3fameter------3' !I-----Depth r°^ ., ? -00 _1Z ter s Cesspool: Distance from nearest well___ -__--______._ Distance from fo nd _-..______________. ationLining material____________________ --------------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------- gals. Privy: Distance from nearest well____---------------------------------------------Distance from nearest building ❑ Distance to nearest lot line-------------------------- ------------------------------------------•-- Remodeling and/or repairing (describe)___________________________ _______________ --------------------------------- ------------ ---------------------------------------------- ---------------------------•-----------------------------•------------------------------------•-------------------- j I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd ul sand regulations of the San Joaquin Local Health District. I (Signed) - �--- --=----- - ------------- ----------------- ------------ -----------------------------------------------------------------------(Owner and/or Contractor] By:-------------•------------------------------------------------•-------------------------------------------------------------------•(Title)-------•----I--------------------------------- --------------- (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 REVIEWED BY------------------- --------- DATE " r ------------------ - `- BUILDING PERMIT ISSUED------------ a Alterafiion� and/or recomme, ations:__ ' ,� -- - —DATE ------------------------------------ -A-- ------------- x V , ------------------------- ----------- --------- FINAL INSPECTION BY:. . --------•--- -- ---- - T ' Date--- -- ---- --------_z_S' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street aro North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M , Revises 1.57 FY.CO. b