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v APPLICATION FOR SANITATION PERMIT Permit No. ._ _T--P___ . ' (Complete in Dupiicite) 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. t JOB ADDRESS AND LOCATION--------,�/ 'S� _. .Gtr-t ------- -------------------------------------------------------------------------------------- Owner's Name .: � ---------- Phone------------- ---------------------------=------------------------------------------- Address---------- ------ Y , � -------•---------------------------------------------- ------•--------------------------------------- r Contractor's Name------ = --------------------- Phone i ------------------------------------------------------------------- Installation will serve: Residence Apartment Houle ❑ 16ommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�____ Nu b of bedrooms _ 4N�mber of baths __`__ Lot size _t �-X____�,�,eP____________________________ Water Supply: Public system ( -n unit s stem Private Depth to Water Table ._ f1_ it. pp y Y t Y Y ❑ p Character of soil to a depth of 3 feet;' Sand ❑ Gravel ❑Lrand'y Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan El Previous Application Made: Yes ❑ No , New Constr ction: Yes ❑ No g�FHA/VA: Yes ❑ No~®� �. 44 TYPE OF INSTALLATION AND SPEC IFICATIONS: • Sept' TankSeptic tank stancesfroml Peare'st� welf:,rpubiic sewer stanw�lable within 200 feet.) 1 --- -_-D , from foundation--------------------Material------------------------------------------------- ' No. of compartments--- - - ----------Size-------7!--------------------Liquid depth-------------------------_Capacity----------------------- Dis osa Field: Distance from nearest well---!-._-_�'_...Distance from foundation---h!V---------Distance to nearest lot line___s }t Number • --Length 'a f!each line------ of french_____ _ Type m l` Depth of filter material-----//! --------Total length_______ Seepage Pit: Distance to nearest well______"^'-___._____Distance, om f ndation__J,#__._.___..Dista`,e to nearest lot line---a1f_-------- Number of pits-------/-----------tLiningrmaterial== _=-SizeDiameter----, ---------.Depth...... .---------------- i Cess❑pool: Distance from nearest welli_______________Disttance from foundatio m-----_-__.__-____.Lining material__._-________________________________- Size: Diameter---------------- -------- ------De th---------------- - ------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well- -------------------------------------- -- g------------------------- _____Distance from nearest building _______________ ❑ Distance to nearest lot line -----------------------------Qu, ----------•--------- -----------�----------------------------------------------------------------------- Remodeling and/or repairing (describe ---------- ----------1 � ---------------- --------------------------------------------------------------------------------d------------------------------------------------------(Ir ------------•-------------------------------------------------------- -- -------------------------- -----------------•-------------------------------------------------------------------------------A------------------------------------------ I hereby certify that I have prepared this application and that the work will lie done in accordance with San Joaquin County ordinances,.State laws, and rules and regul t'on's of the San Joaquin Local Health District. , (Signed)----------------- :----- ----- --- - -- ----_ --------------- --------------------------=------ Contractor) By:---------------------------------------------- -- , �. r=_=- _ _ :�. -------(Title)- (Plot plats, showing size of lot, location f system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE �`----------------------------- REVIEWEDBY------------------------------------------------ ---- --------- -------- --------------------------------- DATE-------fd--- c'u'-�'_---------------------------•-------- BUILDING PERMIT ISSUED--------------------------- ------------------------------ ------ DATE------------ - ----------------------------------•-------- Alterations and/or recommendations:--------- ------------- ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------•---------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- -------------------------------------------------------------------•------------------------------------ -------•------------------------------------------------ ----------------------------------------------------------- oFINAL INSPECTION BY---------------- ----•------------------ -------- -------------- Date----------- -- -&'", ----------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 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 , Revises 1.57 F.P.M