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APPLICATION FOR SANITATION PERMIT Permit No. __.1..- -• (Complete in Duplicate) Date Issued �;/�- f�-7- z3 70--ods' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 00 This application is made in comp4iance with County Ordinance No. 549. #' C JOB ADDRESS AND OCATION_ ______ _________ ------ --- ----- --- -------------------- ----- ---------- --------- Phone------ ----------------•------••---- Owner s Name------ ------ -----------),.-/A--------------- --------------------- - •-------`----.7---•- Address-----------� Phone_ - v�e� - -------- -- Contractor's Name_______________ '�----�- - ------ �} Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 10 40— Number of living units: -------- Number of bedrooms .------- Number of baths - ----- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table J&_ ft. PP y: Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayX Adobe ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ NO FHA/VA: Yes ❑. N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) S tic Tank: Distance from nearest well__----._.-----_Distance from foundation___________________Material of compartments-----------•--------------Size--------------------------------Liquid depth--------------------------Capacity.---- % , + // r Disposal field: Distance from nearest well..- ------Distance from foundation____�t_0_.___..__Distance to nearest lot line� ____`s_._____. Number of lines------ /----------- - Length of each line------ � -!-----------Width of #Tench_.-� ------------------ iI Lam•----- Type of filter material---;._X -- -Depth of filter material-_..__f_ -___-_---Total length__,APO___._ } p � -------------------------- El I Seepage Pit: Distance to nearest well---_-____.-----------Distance from foundation--------------------Distance to nearest lot line-_---_--._----__- , _ Depth -------------------------- F ❑ Number of pits----------------------Lining material Diameter____________..___-- - - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------------------I SiDiameter ---------------- Depth----------------------------------------------------Liquid Capacity.. •gale I El Size: --------------- - - - 9----------------------------------------- Privy: ---------------------------------- - Privy: Distance from nearest wei!____________________ ----------------------------Distance from nearest buildin ❑ Distance to nearest lot line....___.--_____----------------------- ---------- --------------- - --------- - - - ------------ --------------------- - Remodeling and/or repairing (describe)-----------------------__ ------------- ---------------------•----------------•-----•---- --------- ---------------------------- ---- -----•-------- ------ ---- ---- -- ----- - I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State Ian, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) (Signed)--------------- W " By:---- ------------------------ , t .`--- (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --------------------------- DAT ------------------------------------------------------ ----------------------------------- DATE. REVIEWEDBY----------------------------- -------------------. DATE-----_ 3------ ------•----- ------------------••---------- BUILDING PERMIT ISSUED----------------------------- ----- -------------------------------------- Alterations and/or recommendations:-------------------------------------------------------------------- ecommen ations:___.___._---------------------------- ------------------------------ ---------------------------------------------- •-- ------------- ----------------F-------------------- __-_--- -..- fr� V -- Date----- ------------------- --• ----- ------- ------------ FINAL INSPECTION BY-------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 5 camore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1.57 f.P 120-