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Permit No. . S- APPLICATION FOR SANITATION PERMIT / �/ 1 (Complete in Duplicate) Date Issued �1 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. / L ` ------------- JOB ADDRESS AND LOCATION--------- ' Owner's Name-------- --- Phone. f �' ' ' _ _- Address = s ------------------------------------------------ 4 - ----------- �h -- fl y/��i _ one Contractor's Name --------------- ----------- Ph Installation will serve: Residence IEApartment House ❑ Commercial ❑ Trailer Court ❑- Motel ❑ Other ❑ Number of living units: _./--- Number of bedrooms _-__ Number of baths _---- Lot size _410e__x-- M?----•---------------•-------- 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 ❑ Adobe4?rHardpan ❑ Previous Application Made: Yes ❑ No J�- New Construction: Yes ❑ No g�- FHA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest weallll_--�'----Distance from foundation-Ze---.------Mat`rial----- - ------------ No. of compartments r`' Size-- - -- q p. �---- ---------Capacity E aY �.___Li—&--Liquid de th--.__- ... Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line__------------- Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------- El Type of filter material--------------------- -Depth of filter material-----------------------Total length------------------------------------------ .. � x 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------.---__---------------____.----- C ❑ Size: Diameter---------------------- - - ---------Depth----------------------------- ----------- ----------Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well-- ------------------------------------------- -Distance from nearest building-----------_-_--------------._-__-.-.-_-. oe ❑ Distance to nearest lot line----- ------- --------- --------------------- --------------- ---- -- ---we ' G Remodeling and/or repairing {describe --- / - ----------------------------------------------------------------------- i' - ------------, ,----9 ----' ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances State laWandles and regulation of the Sa oaquin Local Heal District. Contractor) =- ---- tor) i -- ----------------------(Title)---- (Plot plan, showing size of lot, ation of system in.relation to wells, buildings, etc., can be place on reverse side FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- DATE-------------------�'��--=------------------------------- REVIEWEDBY--------------------------------------------- ---------- DATE---------------A,------------------•--------------------- BUILDINGPERMIT ISSUED--------------------=------- --------------------------------------------------------------- DATE--------- -----------------------------------•--------- Alterations and/or recommendations:------------\-- ----•-•--------•-- Date_------ FINAL INSPECTION BY:-.---- - _ _41-- ----------------- =1� `5 -------- ------- ---------------------- 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 Reviseo 1.57 F.P.CO.