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___.�•-�••�1--- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _!_I--� --• 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. ; ---- ---------` --- - v JOB ADDRESS AN LOCATION------ - - �----- � � Owner's Nam --•-------- --•--- •----------------p- n Phone---- Add ress_ -- ` 41- ---Y- -- -•-------------•--------------- Contractor's Name- -------------------------'- ---------- Phone----•---•---------------••--=------ Installation will serve: i Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O er ❑ Number of living units: -f----- Number of bedrooms -�'' Number of baths --/---- Lot size ------- ------ ------------1-4 Water Supply: Public system [/community system ❑ Private ❑ Depth'to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loe- 0 Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ VVA: Yes No ' Previous Application Made: Yes ❑ No 0/— ;New Construction: Yes ❑ , FHA/ ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or'cesspool permitted if pubic sewer is available within 200 feet - ----- Materi?Ij IL�-- !� i ---"`5ept�iE ank�:��"'``Distance'-from nearest-well _� �stan�erfrom�founda�ion__ _____ _ ___.-". T . K __Li uid de th Capacity No. of compartments --------�-f----°--- ¢e_�.--- -�----- --- - q '---� --------------- J �---; YdLc.c✓ . Distance from foundation;✓_ •Distance to nearest lot line Dispas l Field: Distance from nearest w IISQ...___- - t-_. "� Number of;lines_____`______ - .----t------------Length of each.,line------------- �y rrr .Width of trench : ". w Type of filter materi _._--- ---. epth of filter material________ -------- otal length_______________O__--0--------.--------- 4 __`Distance from foundation____________________Distance to nearest lot line_______.______-"- Seepage Pit: • Distance to nearest well__ -- ,.. ------------ -- ❑ Number of pits-- -------------------Lining materia_ -t--------------Size: Diameter Dept Cesspool: Distance from nearest wel ------------------Distance from foundation__ _____________-Lining material___________________.__- ----"els. El Size: Liquid Capacity t = g Size: ameter-------------- - _ ------Depth -------------------------------------- -" Distance from nearest building Privy: Distance from nearest well----------------------- = ❑ --------------•--------------------- Distance to nearest lot line_-__"____________________ -------- Remod orig $nd/or repairin des gibe)-----------------------------=------- ---------------------- f -------------------------------------------------------------•--------------•------•--------------•--------•--- ---------------------- --------------------------""-----------I---------------------------=---------------- •-------------------•----------------•-•---------------------•------------- --------------------------=-------- ----------•------- •------------------------------------------- ---------••-----------•-------------------------- 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, and rules and regulations of the San Joaquin Local Health District. J LV ---------------------------------------------•-------------(O caner and/or Contractor (Signed -------(Title) ------------------------ -- --- ----- ---- ------- lan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse sidel. p -•yc—. .�a:,.a .. -«--.-. a.r— —.....• ;,,__ -ter^._ ?"�.+r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ ___.__ ---------------------------- DATE_ . REVIEWEDBY------------------------ ---------- ------------------------------------=-------------------------------- - --- DATE -- -•-•-----...-------- BUILDING PERMIT ISSUED----------------------------------- ------ -------------------------------------- ---------- ----- DATE--------c-�------------------------ ---------------•------- Alterations and/or recommendations:----------------------.-------------------- --------••----- ----------------=------ ---------•----------------- ------------------------------------ ---------------------- -- ----------- ----- -----•-------- ------- ------ ------ ----- Date----- -- --------- ------------------------------ FINAL INSPECTION BY:._------- -- - ---- y---------------- ------�L SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Manteca, California Tracy, California Stockton, California Lodi, California ES-9-2M Revised 1.57 E CO.