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-APPLICATION FOR SANITATION PERMIT Permit No. -1/2)_51 (Complete in Duplicate) / Date Issued -__./_�al_!Q ___ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap,plication.is made in.coinpliance with County Ordinance No. 549. JOB ADDRESS AND OCATfON ----- rpt��. � - ��_. .--------_ --_ ----'--------- ---- -------__----- ..____ Owners Name -------------------------- ------ Phone------------------------------ ' " ' '� Address----- -- ----'------------=----b-� :?; �•----s -------- -- Contractor's Nam P ------------- Phone----------------------------------- 1 p,. ❑ ❑ Trailer Cour} installation will serve: Residence A artment.,House Commercial - � � ❑ Motel ❑ Other ❑ Number of living units. 1C-_._ Number of bedrooms ZX—Number of baths _1_____ Lot size ---jllt: k _ "7J__________________________ Water Supply: Public system ❑ Community system ❑ Private ) Depth to Water Table 6- ft. Character of soil to a depth ofr3 feet: Sand ❑ Gravel ❑ Sandy Loam g Clay Loam K Clay ❑ Adobe ❑ Hardpan ❑ �� Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION. AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer-is available within 200 feet.) J Septic Tank: Distance from nearest well___- _--Dista ceyyfro f dation-_ -- ___--.Maternal-----a ��Cl----------------+� No. of compartments__ _ -______________Size- ___7_'_ __��__"___..__Liquid depth--... _ Capacityf�� ; - -- - --------- Dispoosal Fieicl: Distance from neare t well__ ``--Distance from foundation-2-0______..--_Distance to nearest lot linel_Q_�--____- / _. . Number of lines_.....-�__ _________ __ __ _6e_ngthyof each _ �_ _ ......... Width of french---- Type of filter materia _-, Depth of filter material ____________Total length___ _________________________-_ Seepage Pit: Distance to nearest we I_,-_d__ ___ Distance from foundation__________________.Distance to nearest lot line_40--__.____. Number of pits-----.3--------------Lining material FSize: Diameter--- - ^'..--- Depth - --- ------------------- Cesspool: Distance from nearest well_________________Distance from foundation______--------------Lining material ____--_________---_.-______---__-___. ❑ Size: Diameter------ -------- ------------------ ----Depth- :`-------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well___•_---------------------------------------------Distance from nearest building------------------------------------------ Distance ___----.-._________--____________ _Distance to nearest lot line--- ------------- ---- - Remodeling and/or repairing (describe):---------------------- ----------------------------------------------------•----------- --------------------------------------------------------------- -------------------------------------- ----------------------•-•'-------- ----------------•--------------------------•--------------------------------- 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. (Signed). `* % -------------(Owner and/or Contractor) i By:---------------•-------------------.....-------------------------r-------------------------------------------=----------------------(Title)=------------------------------------------------------- (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 -, g REVIEWEDBY------------- --------------------------------------------------- -------------------- -------------------------------------- DATE BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations--------------------------------------------------------------- -------------------- -------- - _ ------------- ---- ,,�_ ------------ -- ----- ------ ---- --------------------------------------------------------------------------- ----------------- ---------------------- ------ - -- ---------------------------- -------------------•---------------------•-------------- ------------------------•-------------------------------------------------------•-------- FINALINSPECTION BY:. `-- -------•------------------------------------------ Date------- ------------------------------------------------------------------•---- I 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-4-2M , Revised 1-57 F.P,CO. Y -